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Beware those prescription drug co-pays

Drug costs are becoming more complex
Drug costs are becoming more complex
Photo by Mario Tama/Getty Images

As we approach open enrollment for the next round of Obamacare, one of the most important considerations should be your chosen company's prescription drug coverage. In a Sunday, August 31, 2014 New York Times article ( entitled "Those Rising Co-Payments for Prescription Drugs", the author, Charles Ornstein, provides some important considerations regardng these costs and what the consumer can do to be better prepared.

It used to be that drugs were either generic or brand-name. Generic drugs were much cheaper, and most doctors would prescribe generics whenever possible. In addition, generic drugs had one co-pay and brand name drugs a separate co-pay. Not any more. Today, because of the prescription drug mandates in Obamacare policies, insurance companies are using multiple cost tiers in their private plans. And, further adding to the confusion, generic drugs aren't as cheap as they used to be.

So, what do you pay for your prescriptions? Well, that depends. On what, you may ask? On how your insurance company treats your particular drugs. Some insurance companies have increased the percentage you pay for the more expensive "generic" drugs, almost as if they were brand name drugs. Each company has what is called a "formulary", setting its own list of approved drugs and out-of-pocket costs, so your co-pays may be different than your neighbor's. Extremely expensive drugs simply have a coinsurance instead of a percentage. Abilify, for example, an anti-depressant drug, costs approximately $2,200 for a 30-day prescription; the typical coinsurance payment for this is about $750.00.

Take some time to visit your company's website and research the costs of your prescriptions. They will have their formulary listed, with which drugs fall into which tiers. But beware, here, too. This is only the first step in determining what you'll pay. Different manufacturers of the same drug may charge different rates. The form you drug takes - pill, capsule, granules, may also play a part in the cost. Some advice: make sure you sign up for an account with your company online, and review your plan and claims. If you have a problem, or find a discrepancy, call the company and ask. Finally, remember that open-enrollment gives you the opportunity to change insurance companies. If you don't like the costs your current company is charging you, shop other companies. If this is your first time obtaining insurance, this research should prove invaluable. Of course, monthly premiums must be taken into consideration, but if your savings will be eaten up by prescription costs, how valuable is your plan?

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