Humana Introduces RxAllowance Benefit Plan

In the summer issue of Humana’s YourPractice, we told you about a new approach to prescription drug coverage called an “allowance benefit.” Now, we are pleased to introduce a specific application of this innovative pharmacy allowance design: the RxAllowance benefit option.

With the RxAllowance benefit, drugs are grouped according to their ability to help prevent a serious medical episode or the need for further medical care. Humana pays an allowance to a participating pharmacy for each prescription or refill. The member pays the balance, if any, of the amount due to the pharmacy. If the cost of the covered drug is less than the specified allowance, the member pays nothing for the prescription.

The drug groups and their corresponding allowances are as follows:

• Group A includes brand and generic drugs that are used to treat conditions such as asthma, bacterial infections, juvenile diabetes and drugs that prevent pregnancy.
  Allowance: Up to $30 covered per prescription or refill
• Group B includes brand and generic drugs for the control of chronic conditions such as cancer, heart disease, AIDS and multiple sclerosis.
  Allowance: Up to $20 per covered prescription or refill
• Group C includes brand and generic drugs that may reduce symptoms and improve day-to-day functioning for people with conditions such as allergies and arthritis.
  Allowance: Up to $10 covered per prescription or refill
• Group D includes brand and generic drugs that may improve the well-being of people with conditions such as obesity, impotency and tobacco addiction.
  Allowance: $5 per covered prescription or refill
• A member’s cost will not exceed $200 per covered prescription or refill for drugs in Group A, Group B or Group C. However, there is no out-of-pocket maximum per prescription for drugs in Group D. There is no annual out-of-pocket maximum for any of the groups.

Physicians can check the group status of specific drugs on Humana’s Drug List, which is made available on www.humana.com.

Humana members can use the Rx Calculator on www.humana.com to research and calculate their anticipated pharmacy expenses with the RxAllowance benefit. This approach supports our goal of helping our members become informed consumers of health care. As such, Humana members with the RxAllowance benefit should be aware and notify their physician that they are participating in this plan; physicians can also identify members with the RxAllowance benefit by the “a” that will appear on their Humana member ID card in the pharmacy benefit line representing allowance amounts for the four groups.

The RxAllowance benefit was first offered to Humana associates and their dependents during the 2003-2004 open enrollment period; those benefits took effect July 1, 2003. In 2004, the RxAllowance benefit will be included in several pharmacy benefit options offered to Humana’s commercial members.

As more Humana members enroll in RxAllowance, physicians and their office staff are likely to hear questions from Humana-insured patients about generic or possible lower-cost alternatives to their prescription drugs. If you have any questions about the RxAllowance plan, contact your provider relations representative.

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