Prescription Benefit Plans

For consumers who have comprehensive health insurance, prescription drugs are covered from day one, often by paying a small co-pay amount for generic and a larger co-pay for brand name. In addition, some insurance plans require that consumers meet a separate deductible within the range of $200-$500 on top of making the co-payment.

Some comprehensive health plans and many more of the less expensive policies don't include prescription drug benefits in their policy, but include it as an add-on option. For people with these kinds of plans, an add-on benefit might prove a worthwhile investment. For a pre-determined monthly fee, subscribers are given discounted prices on their prescriptions, which often saves them from 5%-20% of the amount they would pay at full price. While this may be small for a person who only takes one medication, for those who have major health issues and need to take more than one medicine, these savings add up quickly. 

In California, 23% of those covered by a health plan have to go through a stand-alone plan or buy an add-on prescription drug benefit in order to receive the medicines they need. For those people, and for low income individuals and families, California has a unique prescription drug plan that may be coming out soon. Californian Rx will begin enrolling people in 2006. With this plan, members are provided with a discount card that can be swiped at local pharmacies. This is meant to curb the trend of higher prescription costs and allow the under-insured access to a quality life.

Telemedicine is a hot topic in California, as on-line pharmacies pop up to sell discounted (and often illegal) prescription drugs to desperate consumers. While the act of buying medications from on-line pharmacies is not currently being regulated in the state, the Department of Insurance is investigating such companies to be certain that consumers are not purchasing unsafe medications. The law allows Californians to order and receive prescriptions without a face-to-face meeting with a physician, as long as they are receiving treatment from a qualified doctor at regular intervals.

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