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Prescription DRUG Insurance Plans from Sedona Benefits

Prescription Insurance is designed to save money on prescription drug costs. We will help find low-cost medications within the same therapeutic class as a drug you may be taking currently.

This formulary program has the following benefit tiers:

  • 1st TIER; Generic Drugs - Your payment is up to $10
  • 2nd TIER; Brand Home and Select Generic Drugs - Your payment is up to $20
  • 3rd TIER; Brand Name end Select Generic Drugs - Your payment is up to $50
  • 4th TIER: Brand Name Drugs

Special discount prices have been negotiated that save you money off the retail cost of your drugs. To get the most out of this program you should ask your doctor to prescribe a drug within Tiers 1, 2, or 3 if possible. Often drugs within the same therapeutic class can be prescribed in place of an expensive brand name drug. Of course, if you choose the higher price brand name drug, the substantial negotiated discount still apply.

What is a generic drug?

Once a patent on a brand name drug expires, other drug companies may make a generic version of the drug, with the approval of the Food and Drug Administration (FDA). The FDA's standards for quality are the same for all manufacturers. This means the generic drug contains the same active ingredients as the brand name whose patent has expired, and that it is safe, potent, and effective. Generics are essentially a chemical copy of their brand name equivalents. The color or shape may be different but the active ingredients must be the same for both.

 

The brand name is the trade name under which a product is advertised and sold, and protected by patents so that one manufacturer can only produce it for a predetermined number of years. Once a patent expires, other companies may manufacture a generic equivalent, providing they follow stringent FDA regulations for safety. To determine if a generic equivalent is available simply ask your local pharmacist or ask your doctor to prescribe generics whenever possible and appropriate. There is little difference between brand name same and generic drugs.

Did you know this about Generic Drugs?

50 % of Americans use generics.

According to the FDA, the vast majority of our generics are less expensive than shopping in Canada.

The FDA is speeding up the process of generic manufacturing and estimate a savings to the American people of $35 billion within the next 10 years.

Over 5 1⁄2 million Americans receive free prescriptions or low co-pay prescriptions directly from the pharmaceutical companies.

What drugs are considered preferred (formulary) on the plans?

A preferred drug list is a list of recommended prescription medications that is created, reviewed, and continually updated by a team of physicians and pharmacists. The preferred drug list contains a wide range of generic and brand name preferred products that have been approved by the FDA. Your doctor can use this list to select medications for your health care needs, while helping you maximize your prescriptions drug benefit. A medication becomes a preferred drug based on safety and efficacy, then on cost-effectiveness.

What is the difference between a preferred brand drug versus a non-preferred brand name drug?

A preferred brand drug is a medication that has been reviewed and approved by a group of physicians and pharmacists, and has been selected for preferred status based on its proven clinical and cost effectiveness. A non-preferred brand name drug is a medication that has been reviewed by the same team of physicians and pharmacists who determined that a clinically equivalent alternative drug that is most cost effective is available. These designations may change as new clinical information becomes available.

What drugs are considered preferred (formulary)?

The product guide contains certain brand drugs for which the member's price is the scheduled amount listed. Drugs that are chemically or therapeutically similar to drugs listed on the product guide are not discounted. Prices are subject to change due to manufacturer price changes to pharmacies. On these drugs, the participant enjoys two distinct discounts, one through the pharmacy network and the second through the manufacturer.

What if the brand drug I am taking is not discounted?

If you are currently taking a medication that has similar active ingredients or is used to treat the same conditions as the preferred brand drugs in the Competitor product guide, it will still be discounted. You will pay the negotiated price for that drug. To take advantage of the potential program savings on listed preferred drugs, you should ask your pharmacist (where regulations permit) or a doctor to change your medication, where medically appropriate, to a fess expensive product listed in the product guide.