Allowance Plan Takes New Approach to Drug Benefits
There’s more to prescription
drug benefit plans than copayments and deductibles. A new plan rolled
out to Humana employees last year is based on drug allowances that
help increase consumers’ awareness of their prescription drug
options and costs.
The innovative benefit option — RxImpact (formerly RxAllowance)
— proved popular enough to attract 18 percent of Humana employees
when it was first offered last year. Although it is currently available
only to Humana employees and their dependents, similar allowance
plans may be added to the menu of health benefits at other employers
as early as next year.
RxImpact places covered prescription drugs into four categories,
or tiers (see chart), according to clinical use. Instead of owing
a copayment, a patient who purchases or refills one of the covered
drugs receives an allowance (dollar amount) that reduces the purchase
cost by $5 to $40, depending on the drug’s tier. If the cost
of the covered drug is less than its allowance, the patient pays
nothing for the prescription and the excess allowance is rolled
into a Personal Care Account.
Drug costs are based on Humana’s negotiated price, rather
than full retail, and the consumer’s cost for each prescription
purchase is capped. Plan participants also are protected by maximum
annual out-of-pocket expense limits for drugs in three of the plan’s
four tiers.
To check the tier level of drugs in RxImpact or the status of products
in any other Humana prescription drug plan, go to www.humana.com,
select the “Providers” area, choose the link to “Prescription
Tools and Resources, and then select “Drug List Search.”
RxImpact Drug Tiers
Allowances are highest
in Group A and decrease in groups B through D. Caps on the
total cost-per-purchase apply to groups A through C only.
Group A: Includes brand and
generic drugs that treat conditions including asthma, bacterial
infections, juvenile diabetes, depression, HIV and prevention
of pregnancy.
Group B: Includes brand and
generic drugs to control illnesses and chronic conditions,
such as cancer, heart disease and multiple sclerosis.
Group C: Includes brand and
generic drugs that may reduce symptoms and improve day-to-day
functioning for people with conditions such as allergies,
arthritis and chronic pain.
Group D: Includes brand and
generic drugs that may improve the well-being of people with
conditions such as obesity, erectile dysfunction and tobacco
addiction. |
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