I reached our deductible so I have a month of 80-20 split…so getting in all doctor visits, filling prescriptions, etc.
I started Toprol last month, and from the advice and articles provided by the good people on CC, decided to do brand instead of generic. It’s not much to begin with, less than $40. When I went to pick it up today I was expecting $14 or so, but it was $33. I called Anthem and they said it’s normally $36 and I have to pay 60% since its brand. I told her $33 was more than 60%. She investigated and said I am being charged an additional $11 for choosing brand over generic.
I am certainly not happy about this. Had it happened to anyone else?
Yes, you often have to pay more if you use a name-brand over a generic. Some plans will make you pay 50% or more for a name brand, as you’ve discovered.
Are you saying that the GENERIC is usually less than $40, so your share would be less than $8?
How much is the Name Brand? (not how much YOU were charged, but how much is it?)
Name brands are usually so much more costly than generics that insurance companies have these rules so that people won’t choose name over generic. To slightly twist the subsidize rule: better subsidize what you want more of.
Man, that stinks! After insurance the brand costs $36, which I don’t think is bad…I just wasn’t expecting to pay almost that entire amount after I hit my deductible.
Yes, even tho we have very good Rx and medical coverage, H pays nearly 90% of the brand drug instead of a generic because his MD says switching to the generic could cause him to get goiter. Fortunately, we can afford it. When we use generic Rx, the prices are often very low and sometimes even free with our Rx plan.
Aetna charges us a copay of $35 for brand names “on the list”, $10 or the actual cost if less than $10, and I have no idea what it would cost if the drug is not “on the list.” Can’t wait until I will be able to save $35/month.
We have three levels of coverage…generic, name brand preferred, and name brand not preferred. There is also a list of never covered drugs.
If a generic is available, and we choose the name brand, we pay a huge amount more…unless our doctor writes “dispense as written” for the name brand. Even with that, the insurance company can ask for an explanation from the doctor as to why the generic will not suffice.
Yes, we too are surcharged. There are times when the cost of paying cash is less than our costs as an insured. (I’m talking about other than the $4, etc medications available at Walmart, Kroger, etc).
Your insurance is still covering well over half the cost of the branded medication. A month of branded Toprol XL is over $100 vs under $10 for generic. Many policies won’t cover brands if a generic is available. The brand manufacturer of Toprol XL also makes a generic and they use the same tablets. You can have a generic drug with tablets that have the brand name imprint on them.
The plan I had a year ago charged a penalty for using name brands when a generic was available. But my doctor wanted me to use the name thyroid medication, so I did. However, it is always worth checking GoodRx.com to make sure that it isn’t cheaper to just buy it without insurance. I think yours is still likely cheaper with your insurance, but a good habit to check. I have two other prescriptions that are far, far cheaper to buy at Costco without insurance than using my mail order prescription plan with “free” shipping.
We believe H is getting insurer to pay a few dollars on his brand-name Sythroid, but next time he’s due for a refill, I will check with Costco to see if they have it cheaper. It only takes a quick check and we’re at Costco all the time anyway. I won’t go out of my way because it’s still way under $100 for a 90 day supply.
I worked in group insurance for a short time, and I can tell you that Rx programs are all over the map. There are so many different ways to set up the coverage (because each little change can add to or reduce the cost), and you really have to look at the policy to figure out what’s what.
We have a high-deductible health care plan. We have to pay 100% up to the deductible, then 20% after the deductible. But is we choose a drug that is not on our formulary, we have to pay full price AND it’s not counted toward either our deductible or our max out of pocket. That is a change from they way the coverage used to be, and it was never communicated to us (other than being in the documentation for the plan). My H has been with the same company for more than 39 years (!), and I have learned that I have to read all benefit info carefully every single year. There have been so many changes over the years, particularly since 2008.
There’s the issue. And in many other cases, the differences are even more extreme.
My H’s has some Rx’s that he truly only pays pennies for because they’re generics. Some generics are actually FREE at some pharmacies.
You can see why insurance companies “punish” those who opt for name brands when a much cheaper generic is available. And, you can see why insurance companies reward when generics are used by covering a greater %.
