Drug reimbursement is when a third party pays for all or part of a prescription, with insurance companies handling the process differently. Patients may need to pay a co-pay, and some plans encourage the use of generics. Not all drugs are covered, and patients should check with their insurance carrier before filling a prescription.
A drug reimbursement refers to a situation where a third party pays a pharmaceutical company for all or part of a prescription, or where a third party reimburses the consumer for part or all of the price of the prescription. Various insurance companies may handle the process in different ways, and in some cases it may depend on the drug manufacturer. Drug reimbursement is often a benefit of a health insurance plan, although not all plans offer prescription drug benefits.
In cases where the drug manufacturer is reimbursed, the consumer is responsible for doing very little more than going to the location and picking up the drug. Depending on the plan, the consumer may need to offer some money toward the cost of the prescription known as a co-pay. The pharmacy then handles the rest of the transaction by submitting a claim to the insurance company noting the drug of choice, prescription, date dispensed, and other relevant information. This can be done on paper or by electronic network.
For drug reimbursement plans that rely on the patient to handle the claim, the patient generally must pay the full cost of the prescription up front. This may create at least a temporary hardship for the patient until the money is reimbursed. This can often be a method that insurance companies choose to encourage a patient to take a generic drug, which will create fewer temporary out-of-pocket costs for the patient and the insurance company. The change for drug reimbursement can vary with each company and the number of claims that are processed.
No matter which method is used, the general trend in drug reimbursement strategies is to encourage the use of more generics. This can significantly reduce costs for insurance companies. For example, in the second quarter of 2009, the average price of a brand name drug was approximately $143 US dollars (USD). The generic equivalent costs $20.48 USD on average. In addition to the strategy of having the patient pay the costs up front, some pharmaceutical companies encourage the use of generic drugs by paying only for a small portion of a brand name drug if a generic is available, rather than paying all or most of it. all of the medications. generic.
Not all companies that offer drug reimbursement will make all drugs available under the plan. For example, some medications may be considered quality-of-life enhancements and are therefore optional and not subject to reimbursement. Certain insurance providers may also have relationships with certain drug manufacturers and have exclusive benefits with those manufacturers. Also, newer drugs generally must go through an evaluation process before being reimbursed. Those unsure of what their drug reimbursement plan offers should check with their insurance carriers before filling a prescription.
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