These are all reasonable cost containment methods. Newer approaches to controlling prescription drug costs are more controversial. In a card plan, an insurance company or third party administrator solicits pharmacies to join the plan. The pharmacy agrees to reduce prices in exchange for the plan s block of business. If an employee elects to use a non-participating pharmacy, he or she must pay for the prescription in full and then file a claim for reimbursement.
Most plans apply a penalty if a non-participating pharmacy is used within the service area.
Through bulk processing and purchasing, mail order prescription programs can save money for the plan and the patient. Typically, mail order programs require lower copayments than those that apply to prescriptions filled at local pharmacies. Also, prescriptions are usually filled with 90-day supplies, rather than 30, as is typically the case with pharmacy filled prescriptions. Critics of mail order programs point out that they do not always save the plan money for two reasons. These are not good reasons to eliminate the mail order option.