Routine Prescriptions with No Coverage

All Complementary Benefits Executive Health May 30, 2018

Employee Benefit News recently published an article that told accounts of people with chronic illness unable to afford routine prescriptions even with their health insurance.

One story, in particular, mentioned a woman with diabetes who said this of her prescription coverage: “Honestly, I’m still paying as much as I was paying in school without health insurance.” Her high deductible health plan doesn’t provide coverage for the routine prescription she needs.

A New Trend for Routine Prescriptions?

The other reports were similar. A woman with high cholesterol lost coverage for the medication she needed when her company’s health insurance plan changed. She stopped taking it all together, despite needing it for her health, because the $400-a-month price tag was too high. Another woman faced high out-of-pocket prices for asthma medication.

It’s common knowledge that prescription prices are on the rise, even for routine prescriptions, but another change to keep in mind is the shift to high deductible health plans that include prescriptions inside the deductible. Where there may have once been coverage, there isn’t anymore without first reaching a steep deductible.

These high out-of-pocket costs are pushing patients to stock-up on free medication samples, skip days, or worse, give up the medication all together and keep their fingers crossed.

Not only is this dangerous for employee health, but it can also lead to presenteeism when employees come to work sick or preoccupied. Presenteeism can tremendously reduce productivity and negatively impact a company’s bottom line.

What Can Employers Do?

To help offset some of these out-of-pocket expenses, employers often offer supplemental voluntary insurance, such as hospital indemnity or critical illness insurance. But it’s important to understand that these types of plans are event-driven, which means unless a specific disease or event occurs, the employee will receive no coverage. That means that routine prescriptions don’t typically receive any coverage. Plus, voluntary insurance is usually employee-funded, so it’s just another expense they’ll have to pay.

Supplemental expense reimbursed insurance, however, is an employer-funded benefit that provides coverage for both routine expenses (including prescriptions) as well as those more unexpected expenses. There aren’t any event-driven limitations, so coverage is available for eligible prescriptions up to the specified limit. It can also help offset employee presenteeism costs.

Expense reimbursed insurance can fill this very important coverage gap where employees really need it.

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