How to evaluate a prescription savings benefit for employees
A prescription savings program may give employees another way to compare medication prices. Before adding one, find out how it works and what an employee has to do at the pharmacy.
Ask which medications and pharmacies participate, how employees check a price and what the program costs. Find out what happens when another payment option is cheaper. A general promise to “save on prescriptions” leaves too much unexplained for either a purchasing decision or an employee announcement.
Understand whether the offer is insurance or a discount
A prescription discount program can change the price available through a particular arrangement. It is different from prescription insurance: a discount does not establish that a health plan covers the medicine or that every prescription will cost less.
The Federal Trade Commission cautions that medical discount plans do not replace health insurance. Explain that to employees alongside the benefit description. Do not call a savings program comprehensive prescription coverage unless that is the product being offered and the description has been reviewed. (Source: FTC)
Find out what employees present at the pharmacy, whether they need a membership and what fees apply. Check whether the discount can be used with insurance. Employees should ask the pharmacist how the payment options work for their prescription.
Compare the same prescription at the same pharmacy
Compare the exact medication, strength, dosage form and quantity at the same pharmacy. A broad drug-name comparison can conceal differences in the prescription. Prices and pharmacy participation can change, so an old example cannot guarantee the price an employee will receive.
Have the vendor demonstrate a price check. Can employees see participating pharmacies before enrolling, and how current are the displayed prices? Ask who helps if the pharmacy quotes a different price, rejects a discount or presents an unclear charge.
Employees may want to compare the program price with an insurance copay and other prices available to them. Their pharmacist or health plan can explain how the payment choice affects coverage and out-of-pocket accounting. Leave that choice to the employee.
Treat generic options as a clinical conversation
FDA-approved generic medicines must meet FDA requirements, including matching the brand-name medicine's active ingredient, strength, dosage form and route of administration. Employers should leave advice about changing a prescription to the employee's health care professionals. (Source: FDA)
A program may show a price an employee wants to discuss with a pharmacist or prescriber. Those professionals can advise whether a different medication or formulation is appropriate. Do not imply that every prescription has a generic option or that all alternatives are interchangeable.
Tell employees to compare the exact prescription and consult their pharmacist or prescriber about any proposed change. A lower advertised price for a different medicine is not evidence of guaranteed savings.
Ask what the program includes and excludes
Review the pharmacy network and whether it includes mail-order options. Check excluded medication categories or services, dependent eligibility and any enrollment or membership fees. If the benefit uses a medication list, ask where employees can see it and how they learn about changes.
Check whether the offer provides a discount or includes medication under a specific benefit arrangement. Those models can have different terms, and employees need a clear explanation of which applies.
Use vendor demonstrations and published information to evaluate prices. There is no need to collect employees' prescription lists. Direct personal medication questions to the provider, pharmacist or appropriate clinician.
Give employees a practical set of instructions
Show employees where to check prices, what to take to the pharmacy and how to compare payment options. Include a contact for problems. Explain that savings depend on the prescription and the program's terms.
Ask LASO Health about WorkWell Meds if you are evaluating medication support for your workforce. Review the current arrangement, available medications and pharmacies, eligibility, fees and employee instructions before announcing it. Describe the actual terms and make clear that it does not replace comprehensive health insurance.
