Healthcare Navigator
Managing your HealthCare expenses is more important than ever. Use these simple, yet effective reminders to help lower your expenses, and get the most out of your benefit programs.
Stay In-Network
Your medical insurance carrier has contracted with thousands of qualified physicians, and it is important to stay “In-Network” whenever possible. (Note: HMO patients must utilize the network to have coverage). In-Network providers and your insurance company have agreed, in advance, on what they will charge for a specific service. However, out-of-network providers haven’t agreed to a set fee schedule and as a result, you’re fully responsible for the difference between the contracted rate and the amount charged by the out-of-network provider. We have highlighted some of the differences below:
| In-Network | Out-of-Network | |
|---|---|---|
| Choice of providers | Yes | Yes, but cost will be higher with out-of-network |
| Lower co-insurance | Yes | No |
| Lower out-of-pocket costs | Yes | No |
| Discounted fees | Yes | No |
| Claims filed for you | Yes | No - you must pay first, then file the claim yourself |
| Preauthorization filed for you | Yes | No |
Mail Order Rx
If you take medications on a long-term basis, receiving your prescriptions through our mail-order service is ideal. Not only will you save time and money, but image the convenience of having your prescriptions delivered right to your door at no additional cost.
- Save time and money - Most insurance programs offer incentives to order by mail. In most cases, you can order 3 times the supply for only twice the co-pay - a savings of 33%.
- Free home delivery - Within ten to 14 days, your prescriptions are filled and delivered via standard shipping for free.
- Safe and reliable - Registered pharmacists check every order. Prescriptions are shipped in plain, weather-resistant pouches for your privacy and protection.
- Professional service - Mail order services are staffed with registered pharmacists, and are ready to help day or night.
- Easy to use - Simply complete the order form and your doctor can fax it to the number listed on the form. Once you begin using the mail-order service, refills can be ordered by phone or online.
| Is Mail Order Right for Me? | |
|---|---|
| Yes, If You | Want access to a registered pharmacist 24 hours a day, every day |
| Take certain medications on a long-term basis | |
| Want prescriptions delivered right to your door | |
| Want to save money | |
Use Generic Drugs
What is a generic drug? It’s identical to a brand-name drug in dosage, safety, strength, qualify, performance and how it’s used. A generic drug has the exact same active ingredients as the brandname drug - inactive ingredients, such as color or flavor, may be different.
What is a brand-name drug? It’s a medication protected by a patent. That means the drug manufacturer has the sole right to sell the drug. When the patent expires, other manufacturers can then apply to the FDA to sell generic versions of the drug.
So what’s the difference? Generic drugs cost significantly less than brand-name drugs - potentially as much as 70 percent less. That means you can save money without sacrificing quality.
Generic drugs cost less than brand-name drugs for one simple reason: drug manufactures spend a lot of money on researching, developing, marketing and advertising for brand-name drugs. These costs are built into the price you pay. Manufacturers of generic equivalents have much lower costs, so the savings are passed on to you. The chart below represents five of the most widely used brand name formulas with generic equivalents.
| Brand Name | Generic Equivalent | Condition Treated |
|---|---|---|
| Prozac | Fluoxetine | Depression/Anxiety |
| Ambien | Zolpidem | Insomnia |
| Imitrex | Sumatriptan | Headaches |
| Ritalin | Methylphenidate | ADD/ADHD |
Generic Drug Programs
Programs are available where it is possible to obtain a wide range of generic prescription drugs for $4 for a 30 day supply and $10 for a 90 day supply. This may enable you to obtain some or all of your generic prescriptions for a lower co-payment than through your own medical plan. Walmart, Ralphs and Costco can also fill your prescriptions that are not covered by their special $4 generic program, and your regular medical plan co-payments will apply.
Details about Walmart’s $4 generic program can be obtained from www.walmart.com/pharmacy, including a list of hundreds of generic drugs that are covered and instructions on how to transfer an existing prescription or fill a new one. This can be handled on-line or at your local Walmart or Sam’s Club pharmacy. Walmart has the option of in-store pickup, or free home delivery of 90-day prescriptions. You can also set up an automatic refill option via their website and it will be mailed to you.
Costco is one of the largest consumer goods wholesalers in the country, with hundreds of convenient locations. In addition, they operate a powerful mail order pharmacy service, where you will be able to fill new prescriptions, transfer an existing prescription, and re-order online. Their pharmacy representatives are available 24/7, and the website has an easy to use Drug Pricing calculator. For those without prescription drug coverage, Costco offers a special program with even lower pricing, called the Costco Member Prescription Program. For details, go to www.costco.com.
Full program details can be obtained directly from Walmart and Costco.
