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Comparing Drug Coverage
Old 11-24-2014, 03:41 PM   #1
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Join Date: Oct 2010
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Comparing Drug Coverage

As one shops for a HI policy, one factor might be prescription drug coverage. But as far as I can tell, you can't really compare, can you?

The only valuable thing that's disclosed is if your drug is on their list or not. Yes, they tell you what "tier" the drug is on, but who cares? When you're going for an HDHP, I pay 100% until the deductible, then zero, so the tier doesn't's just an artifact of policies that had different copays for different tiers. The tier indicates generally how expensive the drug is, but I already know that. In those lists, they also tell you limitations, like if you need prior approval. Ok, that's just a hassle, but not a show-stopper.

They have various lists (and because they want to be as confusing as possible, they call them "formularies"), and some policies are associated with one list, and some are associated with another list, but they don't tell you what the difference is between the various lists. Open, closed, basic, enhanced, 4 tier, 5 tier, whatever, it's not meaningful!

They present the lists in PDF format, so you can't get it into a spreadsheet and compare the lists (very easily).

And they don't tell you what price they negotiated for the drugs! For someone who's probably not going to hit the HDHP deductible, the price they negotiated matters. I don't know that insurance company "A" negotiated better than insurance company "B". The first time you can find out the price is when you're standing in the drug store!

How can we shop in a marketplace like this, where we don't get the information we need to make a good decision?
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