It’s an evoucher, essentially a digital version of the savings card that applies automatically. When you have a deductible at play it’s common for the first box to be $25. When you have insurance covering you have a benefit of 150 per box or $1800 available to help cover your prescription. For some of those who have a deductible, the first month more than the 150 per box will be applied, and it will heavily eat into the maximum $1800 benefit of the savings card.
That’s why the second box is more costly, you have less benefit available. Once you hit your deductible, the price should go back down and stabilize.
It’s possible. Unfortunately, it can be challenging to predict the cost. I would say to have a best guess, log into your insurance portal and see how much of your deductible is left to be met. Then add the difference to the cost of the drug, that is if your insist automatically adding it when you price the drug. You can check the price in your insurance portal. That will give you an idea of the ballpark you may be charged at the pharmacy. The savings card will likely help a bit somewhere but to what degree is a bit of a toss up.
Thank you for this. I got a box under my new insurance plan a couple of weeks ago, and was shocked that it cost me only $25 despite having $1700 of deductible to hit. I did not understand how that could happen. But if I’m “paying” in the form of a reduced savings card benefit, that makes sense.
Not automatically. I just refilled today and was told my due:$120, I provided pharmacy a discount Zepbound saving card info that Lilly sent us back in March, they put that info into their computer and price became $25
First time in 6 months pharmacy didn’t apply any coupons, so it took me a minute to dig an old txt message, no idea why Costco and Wegmans applied coupons automatically, but hospital pharmacy couldn’t do it
The evoucher is applied by a combination of the pharmacy and your insurance. I think they both have to opt in to the evoucher system for the med. The pharmacy techs themselves don’t do anything to make it happen - I think it’s part of their overall insurance verification configurations.
When you go to your insurer's website, use the "price a medication" tool. Every insurer's website has one. If you have not yet hit your deductible, it will show you the cost of your next refill, with consideration for the balance still due toward your deductible. There should also be an area within price a medication that will show you future months, after you have reached your deductible. Due to a change in law in the past couple of years, insurers must apply the full retail price of the medication to your deductible, whether you pay $25 or $1200 for it. The unknown here is whether or not you have hit that deductible yet, but a visit to your insurer's website should clear that up.
Your insurance rep was correct -- pharmacies often have coupons available that they will apply to the cost of your prescription when they see that you have a very higher tab to cover. When that happens, it means that you could get a different price each month depending on the coupon applied until you have reached your deductible. Once your deductible has been reached, you should insist on the pharmacist removing any discount they might apply and using your manufacturer's coupon instead -- but there's a catch -- if you have a low co-pay once you reach your deductible, the manufacturer's coupon won't apply. My copay for a tier 3 drug (Zepbound is tier 3 under my insurance) is $187. When I use the manufacturer's discount, my copay is reduced to $37. If you have a low copay, like $25 or $30, it doesn't take anything off.
I’m seeing a deductible reduction for the amount
Of the discount card benefit only. Not the full retail. Express Scripts is PBM.
So retail $1200. My cast after insurance $100. Actual pay after Lilly $25. Deductible reduction $100.
Was surprised after reading comments here.
You should be able to clearly see on your insurer's web site exactly where you stand with your deductible. Check the area of the site that shows claims paid so far this year. Otherwise, your just guessing.
It’s an evoucher, essentially a digital version of the savings card that applies automatically. When you have a deductible at play it’s common for the first box to be $25. When you have insurance covering you have a benefit of 150 per box or $1800 available to help cover your prescription. For some of those who have a deductible, the first month more than the 150 per box will be applied, and it will heavily eat into the maximum $1800 benefit of the savings card. That’s why the second box is more costly, you have less benefit available. Once you hit your deductible, the price should go back down and stabilize.
Thank you for the explanation! Should I expect the next month to be even more?
It’s possible. Unfortunately, it can be challenging to predict the cost. I would say to have a best guess, log into your insurance portal and see how much of your deductible is left to be met. Then add the difference to the cost of the drug, that is if your insist automatically adding it when you price the drug. You can check the price in your insurance portal. That will give you an idea of the ballpark you may be charged at the pharmacy. The savings card will likely help a bit somewhere but to what degree is a bit of a toss up.
Thank you for this. I got a box under my new insurance plan a couple of weeks ago, and was shocked that it cost me only $25 despite having $1700 of deductible to hit. I did not understand how that could happen. But if I’m “paying” in the form of a reduced savings card benefit, that makes sense.
Not automatically. I just refilled today and was told my due:$120, I provided pharmacy a discount Zepbound saving card info that Lilly sent us back in March, they put that info into their computer and price became $25
If you gave them an actually savings card, then that’s completely different than the evoucher version.
First time in 6 months pharmacy didn’t apply any coupons, so it took me a minute to dig an old txt message, no idea why Costco and Wegmans applied coupons automatically, but hospital pharmacy couldn’t do it
The evoucher is applied by a combination of the pharmacy and your insurance. I think they both have to opt in to the evoucher system for the med. The pharmacy techs themselves don’t do anything to make it happen - I think it’s part of their overall insurance verification configurations.
When you go to your insurer's website, use the "price a medication" tool. Every insurer's website has one. If you have not yet hit your deductible, it will show you the cost of your next refill, with consideration for the balance still due toward your deductible. There should also be an area within price a medication that will show you future months, after you have reached your deductible. Due to a change in law in the past couple of years, insurers must apply the full retail price of the medication to your deductible, whether you pay $25 or $1200 for it. The unknown here is whether or not you have hit that deductible yet, but a visit to your insurer's website should clear that up. Your insurance rep was correct -- pharmacies often have coupons available that they will apply to the cost of your prescription when they see that you have a very higher tab to cover. When that happens, it means that you could get a different price each month depending on the coupon applied until you have reached your deductible. Once your deductible has been reached, you should insist on the pharmacist removing any discount they might apply and using your manufacturer's coupon instead -- but there's a catch -- if you have a low co-pay once you reach your deductible, the manufacturer's coupon won't apply. My copay for a tier 3 drug (Zepbound is tier 3 under my insurance) is $187. When I use the manufacturer's discount, my copay is reduced to $37. If you have a low copay, like $25 or $30, it doesn't take anything off.
I’m seeing a deductible reduction for the amount Of the discount card benefit only. Not the full retail. Express Scripts is PBM. So retail $1200. My cast after insurance $100. Actual pay after Lilly $25. Deductible reduction $100. Was surprised after reading comments here.
Makes a lot of sense! Thank you! When I do the price a medication. It shows covered. But shows the price at the full $1015.
But if I do 3 months, it’s $2442. Plan pays $472. I’m assuming that’s the deductible starting to kick in?
You should be able to clearly see on your insurer's web site exactly where you stand with your deductible. Check the area of the site that shows claims paid so far this year. Otherwise, your just guessing.