Drug Caps

If your health insurance limits how much it pays for prescription drugs each year, your health could be the worse for it.

As independent brokers in the health insurance market we are seeing more carriers and more plans instituting caps on items such as medication. Personally, I refuse to offer such a plan and warn clients & potential clients about the dangers of accepting a plan with caps.

Some listen, some don’t.

For diabetics, heart patients and those with high cholesterol, such decisions can be deadly.

Some of the popular cholesterol meds can run $150 per month. The hidden pricing of meds is an offshoot of drug copays popular with many plans. I have had people tell me they are not worried about a $5k cap on meds because they only pay less than $100 per month in copays and will never imagine blowing through a $5k cap.

One of the people who told me this was taking 8 meds for a total wholesale cost in excess of $600 per month. Without adding any new meds she would blow through a cap in 8 months.