<p>We just got our health insurance information for next year. This is what it says about copays for mail order prescriptions:</p>
<p>$20 Generic
20% with $60 max formulary brand
40% with $90 max non-formulary brand</p>
<p>What the heck does this mean (and my spell check says that formulary isn’t even a word)? Does this mean that our co pays could be $90 per prescription (it’s for a 3 month supply). Right now we have a $60 co pay.</p>
<p>I’m asking because my H is on a very expensive medicine (Enbrel) which I think costs around $12,000/yr. I need to adjust our flexible spending account based on what we anticipate we will spend next year on health costs. </p>
<p>I’ll have my H call his HR person about this later but he’s out of town right now and won’t be able to get to it probably this week and I am very curious.</p>
<p>You need to go to the insurance company’s website and look at the formulary. If Enbrel in on the preferred drug list (formulary) then your max cost is $60 each time it’s filled. If it’s not on the formulary, then it’s $90 for each fill. </p>
<p>Good luck.</p>
<p>(FYI - I just checked my insurer, a BCBS plan. For them, Enbrel is on the formulary. Hopefully that’s a good sign for you.)</p>
<p>deb, a formulary is a list of medications. that’s saying 20 dollar co pay for generics, and then for your brand names they are either formulary or non formulary - normally they say preferred or non preferred - but you need to look up which list Embrel is on to determine which it falls under. you will pay 20 percent of whatever the cost is, with a cap of either 60 or 90 dollars depending where it falls.</p>
<p>Enbrel may or may not be on the formulary. I am familiar with this medication from my work as a medical administrator. Usually, special authorization is needed for this rx, and not all plans will even cover it, so be happy if yours does. (It was my understanding that it might be even more than $12k if you had to pay full cash for it.) </p>
<p>Whatever your insurance, you should go to enbrel.com to see if you can get financial assistance for your copay. There is a formal program to help people get their medicine. There are forms to fill out and if you qualify you get another card to use with your insurance so that some of your copay is picked up by the sponsors.</p>