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Save money on some generic prescription drugs

 


Are you a retiree on a fixed income? Are you looking for options on how to stretch your monthly retirement check? Wal-Mart/Sam's Club, Target and possibly some other stores offer a prescription drug program that could help you. These generic drug programs are independent of insurance coverage options and are available to everyone, including retirees who are covered by any option under the State Health Benefit Plan (SHBP). They offer a thirty-day supply of certain generic drugs for a $4.00 flat fee.

 

 

These generic drug programs could save GSRA members a significant amount of money. For details of the Wal-Mart program go to www.walmart.com, click on "Pharmacy" then choose "Generic Drug Program", where you will see a list of drugs included in the offer. Or, go to www.target.com, click on "Health" then choose "Pharmacy & Prescription" to see program details for Target.

 

 

To demonstrate a retiree's savings under the $4 generic plan, the pricing of one generic drug was examined. However, one must first determine the copayment under the SHBP option and how much the SHBP will pay to the pharmacy for the prescription.

 

 

All options under the SHBP, except for the High Deductible Health Plan, require a $10 copayment for Tier 1 prescription drugs. As a general rule, Tier 1 pharmacy consists of generic drugs. Therefore, if your physician has authorized generic substitution and that generic drug is included on the $4 program with Wal-Mart and/or Target, you can save $6 for each 30-day fill or refill. Your $4 purchase in one of these programs also saves the SHBP the difference between the normal $10 copayment and the State's allowed price for the drug. The allowed price, payments, and savings for the sample generic drug are as follows:


 

Where Purchased Price Allowed by SHBP Option Your Cost or Copayment SHBP Pays Pharmacy
Generic Drug from pharmacy $25.00 $10.00 $15.00
Generic Drug from Wal-Mart or Target   $4.00 $.00
Savings to Retiree
Savings to SHBP
$6.00

$15.00

 

 

This is a win-win situation since you took less money out of your pocket and there was less cost to the SHBP.

 

 

If you are enrolled in a Medicare Part D prescription drug plan that has a front-end deductible (normally $265 for 2007), coordination between your Medicare plan and the SHBP should generate the same savings as shown above. In other words, if you have not met your Part D deductible, you would pay $4 and save $6 with the SHBP saving $15. If the prescription claim has been properly filed with both plans, you should pay only the SHBP option's copayment until the price allowed by your Part D plan reaches the Medicare Part D deductible. In the example, the $4 will accumulate toward your Part D deductible.

 

 

If you have met your Part D deductible, your payment may be as low as $1, depending upon the Part D plan in which you are enrolled. In this case, your Part D Plan would pay $3 to the pharmacy. Remember, for your maximum savings, your pharmacy MUST file your drug claims with your Part D Plan and with the SHBP. Although all pharmacies should automatically file with both your Part D Plan and the SHBP, you should always inspect the receipt or ask each time you fill or refill the prescription to make sure the claim has been filed with both plans.

 

 

It is important to remember that all generic drugs are not covered by the $4 plan. The total savings for any generic will depend on the price allowed for that drug. Also, it is possible that your current pharmacy will match the price of the $4 generic plan so be sure to ask your pharmacy before making any decision on where to purchase prescriptions.

 

 

NOTE: The GSRA membership is being provided with this educational information so that you can make prudent purchasing decisions for you and your health plan. It is not the intent of this educational information to encourage you to change pharmacies.

 

(Originally published in the Newsletter dated March 19, 2007)

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