Regardless of what type of group insurance program you have set up, whether it is a Traditional Group Insurance; Health Care Spending Account; Administrative Services Only or some variation of a Hybrid combination plan, Prescription Drugs are potentially the highest cost item covered.
To combat the rising costs of some Prescription Drug programs, Carriers have introduced different options that work effectively when there is a Generic equivalent:
- Mandatory Generic – If the prescribing physician prescribes a Brand name medication and writes “no substitutes” on your prescription, then the Insurance company will only reimburse you for the Generic drug.
- Standard Generic – If the prescribing physician prescribes a Brand name medication and writes “no substitutes” on your prescription, then the Insurance company will reimburse you for the Brand name.
- Lowest-cost Equivalent – sometimes there is more than one Generic, so if the prescribing physician prescribes a Brand name medication and writes “no substitutes” on your prescription, then the Insurance company will only reimburse you for the lowest-cost Generic.
Of course, some Insurance companies will grant exceptions based on an approval process where you can get reimbursed for the Brand name regardless of there being a Generic equivalent.
Be sure to work with your Group Insurance Broker or Consultant to ensure the correct Prescription Drug plan is in place for your organization and your employees.
Located in Cambridge, ON Sharkey Group Insurance provides independent Employee Benefits advice & counsel for Small Businesses across Ontario.