abbynola Date Rated: 9/6/2016 5:18:49 PM
Silver Script Choice changes during plan years. In 2016, SS has changed formulas to no longer cover previously covered drugs and to move drugs to higher tiers requiring higher copayments. In addition, they require physician review and additional authorization for refills that are deemed high risk for "some" older patients. Disapproval of such medications by SS can result in having to move to much higher cost brand name equivalent medications where low cost generics had been previously used. This results in much higher copayments for the participant or the scripts are filled without insurance and paid for directly. Either way SS revenues go up at the expense of the participant. SS also chooses not to cover certain generic medications in favor of their brand preferences,i.e., Crestor came off patent in 2016 where the generic is much less expensive but SS does not cover the generic. These practices are designed to achieve internal plan cost shifting to participants and can be accomplished without changing advertised pricing or plan design. This allows SS to keep their premiums competitive.