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Rx Deductibles – Avoiding Sticker Shock at the Pharmacy

pillsblueIn Latin, Caveat Emptor means Buyer Beware. It’s usually a good rule of thumb when making any purchase – especially one as important as health insurance. In order to be a smart consumer of health insurance, you need to research all of your options and decide on a plan that caters to your individual health care needs. In the case of prescription drugs, it is wise to know whether or not the plan you choose has a prescription deductible, also known as an Rx deductible.

Deductibles for prescriptions?

We’re serious. Some plans have a Rx deductible – a dollar amount of charges you have to pay for any covered brand-name prescription drug – before any brand name prescription drug benefits are available to you.

I’m confused. Can you break it down for me?

Of course! That’s what we’re here for. Say your plan’s prescription drug co-pay for brand-name drugs is $20 with a deductible of $200. This means that the $20 copayment benefit will not kick in from the health insurance company until after you have paid $200 on brand-name prescriptions out-of-pocket.

Do prescription drug deductibles apply to generic drugs?

No. For generic drugs, you will only be required to pay your generic prescription drug co-pay, even if your plan has an Rx deductible.

Any further advice?

Actually, yes. If you do find yourself with a health insurance plan that carries an Rx deductible, be sure to inform your doctor that you prefer a generic prescription if at all possible. Some drugs may not yet be available in generic versions. However, there may be another option in the same class of drugs that does have a generic version. You’ll never know if you don’t ask.

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