Promotion Q&A
No Pay Copay
- Through December 31, 2007, AmeriHealth Delaware and Pennsylvania will waive copayments/coinsurance on covered generic drugs.
- Through June 30, 2007, AmeriHealth New Jersey will waive copayments/coinsurance on covered generic drugs.
What is No Pay Copay?
What is No Pay Copay?
Why is AmeriHealth waiving copayments and coinsurance for generic drugs?
If a member has a deductible with his/her prescription drug coverage, will the deductible amount be waived?
Who may participate?
Are all AmeriHealth members eligible for No Pay Copay?
Do members have to apply for this No Pay Copay Promotion?
What generic drugs are eligible for the No Pay Copay Promotion?
What is the difference between generic and brand drugs?
What is the difference between a brand name drug and a generic drug?
If these drugs are as effective as brand drugs, why do they cost less?
How does a member know if his/her drug is a generic drug?
How does No Pay Copay work?
How can members take advantage of this program?
What if a member doesn’t want to take a generic drug?
If a member is taking a brand name drug that does not have a generic equivalent, will AmeriHealth waive the brand name drug copayment or coinsurance since there is no generic equivalent?
How does mail order work? (for members with mail order benefits)
Will generic drug copayments or coinsurance be waived if a member purchases drugs through mail order instead of at the local retail pharmacy?
Does the generic drug copayment or coinsurance waiver apply both to refills and new prescriptions filled through mail order?
How does the generic drug copayment and coinsurance waiver apply when ordering a multiple month supply through mail order?
What is No Pay Copay?
What is No Pay Copay?
The program waives the cost of all coinsurance and copayments for new prescriptions and refills for covered generic drugs filled at a participating FutureScripts® retail pharmacy or through the mail order service. We designed No Pay Copay to encourage our members to switch to cost saving generic drugs.
Why is AmeriHealth waiving copayments and coinsurance for generic drugs?
We are offering No Pay Copay to encourage members to talk to their doctors and pharmacists about the appropriate use of generic drugs instead of more expensive brands.
Increasing the use of generics when appropriate will help contain health care costs for our members and groups. Generic drugs provide the same quality, strength and effectiveness as brand name prescription drugs, but generally cost less.
If a member has a deductible with his/her prescription drug coverage, will the deductible amount be waived?
No. Only coinsurance and copayment amounts at a participating pharmacy will be waived. If a member’s prescription drug plan has a deductible, he/she is required to meet the deductible before becoming eligible for the waiver.
Who may participate?
Are all AmeriHealth members eligible for No Pay Copay?
Most members who have our pharmacy benefits are eligible for this program. Not eligible are members with Medicare Part D drug plans and AmeriHealth HSA-Qualified PPO coverage, and AmeriHealth HMO members who belong to the Federal Employee Health Benefits Program.
Do members have to apply for this No Pay Copay Promotion?
No application is necessary. Members simply fill their prescriptions at a participating FutureScripts® retail pharmacy or through the mail order service. For eligible members that pay a copayment or coinsurance for their prescriptions, the pharmacy will automatically waive the copayment or coinsurance amount for the covered generic drug at the time of purchase when filled/processed from January 1, 2007 through December 31, 2007 for AmeriHealth Delaware and Pennsylvania members and from January 1, 2007 through June 30, 2007 for AmeriHealth New Jersey members. Members with a prescription drug program that requires payment in full at the pharmacy and who are reimbursed for their covered expenses will continue to pay the full discounted amount at the pharmacy and will automatically receive a refund check.
What generic drugs are eligible for the No Pay Copay Promotion?
Prescriptions for any FDA-approved generic drugs that are covered by the member’s plan are eligible for this waiver program. The waiver applies to both new prescriptions and refills that are processed and filled between January 1, 2007 and December 31, 2007 for AmeriHealth Delaware and Pennsylvania members and between January 1, 2007 and June 30, 2007 for AmeriHealth New Jersey members (even if previous refills have been for the brand name drug).
What is the difference between generic and brand drugs?
What is the difference between a brand name drug and a generic drug?
According to the Food and Drug Administration (FDA), generic drugs are the same as their brand name drug equivalents in active ingredients, dosage, safety, strength, and performance, and are held to the same strict standards as their brand name drug counterparts. The only noticeable difference in generics and their brand name drug counterparts may be the shape and/or color of the drug. While generic drugs are just as effective as their corresponding brand name drugs, they cost 30 to 70 percent less, which helps control health care costs.
There are also therapeutic generic alternatives, which are not the exact chemical equivalents of the brand name drugs, but they treat the same conditions in the same ways as the brand name drugs.
If these drugs are as effective as brand drugs, why do they cost less?
The lower cost of generic drugs is largely because of their lower advertising and development costs. Generic drugs are not advertised as heavily as brand name drugs.
How does a member know if his/her drug is a generic drug?
The doctor or pharmacist can tell a member if the drug he/she is taking is brand or generic.
Members can also look up drugs by name through www.amerihealthexpress.com.
How does No Pay Copay work?
How can members take advantage of this program?
There are several scenarios.
- Members with new prescriptions are encouraged to discuss the use of generic drugs with their doctors. If the doctor agrees that a generic drug is appropriate for the member, he/she can ask the doctor to write a prescription for the generic drug.
- Members with existing brand prescriptions that have a generic equivalent are encouraged to ask the pharmacist if a generic is available. If one is available, the member can ask that a generic be provided instead of the brand at the next refill. If the doctor indicated on the original brand prescription to “Dispense as Written,” the patient can request that his/her pharmacist fill/refill the prescription with the generic. The pharmacist may contact the member’s physician.
- Members with existing generic prescriptions may continue to use the generic drug. Future refills that are filled/processed between January 1, 2007 and December 31, 2007 for AmeriHealth Delaware and Pennsylvania members or between January 1, 2007 and June 30, 2007 for AmeriHealth New Jersey members are eligible for the No Pay Copay promotion.
- Members with existing brand prescriptions that have a generic therapeutic alternative available for the brand name drug he/she is currently using are encouraged to discuss the use of the generic drug with their doctors and if appropriate, obtain a new prescription for the generic therapeutic alternative.
What if a member doesn’t want to take a generic drug?
A member may continue to use a brand name drug, even if a generic equivalent is available. Members typically pay higher out-of-pocket cost-sharing for brand name drugs because these drugs are more expensive. We encourage members to consider generic drugs, when appropriate, in consultation with their physicians and pharmacists.
If a member is taking a brand name drug that does not have a generic equivalent, will AmeriHealth waive the brand name drug copayment or coinsurance since there is no generic equivalent?
No. The purpose of this initiative is to encourage members and physicians to consider generic alternatives when they are available and appropriate. If there is no generic equivalent, members are encouraged to discuss generic therapeutic alternatives with their doctor and have the physician write a new prescription if appropriate.
How does mail order work? (for members with mail order benefits)
Will generic drug copayments or coinsurance be waived if a member purchases drugs through mail order instead of at the local retail pharmacy?
Yes. We will automatically waive any copayment or coinsurance amount on a generic drug whether filled through a mail order or participating retail pharmacy. Please note: If a member’s prescription drug plan has a deductible, he/she is required to meet the deductible before becoming eligible for the waiver.
Does the generic drug copayment or coinsurance waiver apply both to refills and new prescriptions filled through mail order?
Yes. For refills and new prescriptions, the member’s copayment or coinsurance amount for a covered generic drug will be waived in either situation.
How does the generic drug copayment and coinsurance waiver apply when ordering a multiple month supply through mail order?
Regular prescription drug benefit limitations apply. For example, members who are eligible for a 90-day supply can have their copayment or coinsurance amount waived if they have a covered generic prescription filled/processed anytime during the promotion period. However, members may only receive a 90-day supply of drugs in a 90-day period. Members should refer to their benefit booklet or group contract for additional details on their supply limitations.
