Parenting & Family

Kids prescription fees

[OP]
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Feb 10, 2011
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Kids prescription fees

Before I look further into this anyone have a short answer as to why under my wife’s health plan, all her scripts are $3.99 but my sons are $12.88?
We are all under her teachers health plan? I’m guessing there is more to it then a flat refill fee?
This is at same shop, and her refill fee shows the same $12.88 but is reduced to 3.99 under patient pays. My son’s stays at $12.88
No One Goes to Palmerston Ontario
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Dec 27, 2013
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Redfisher wrote: Before I look further into this anyone have a short answer as to why under my wife’s health plan, all her scripts are $3.99 but my sons are $12.88?
We are all under her teachers health plan? I’m guessing there is more to it then a flat refill fee?
This is at same shop, and her refill fee shows the same $12.88 but is reduced to 3.99 under patient pays. My son’s stays at $12.88
Are the kids receiving brand-name medication when there's a generic available? If so, the prescription should specify "no substitutions" or something to that effect. Our plan changed and no longer covers the brand name if there's a generic available unless the doctor specifies that the brand name is required. A common example of this is with certain ADHD medications where the brand name has a proprietary release system that the generic medication does not have.

Also - where is she getting the medication from? Assuming she's on the same OTIP plan that I'm on, the deductible is only $2. If she's paying $3.99 that means that the dispensing fee is greater than the $11 (I think) that's covered. If you care about that extra $1.99 every time it might be worth finding a pharmacy with a lower fee or that is willing to reduce their fee. The pharmacy that's attached to my GP reduces their fee so that I pay nothing - they even cover the $2.
[OP]
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Feb 10, 2011
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OntEdTchr wrote: Are the kids receiving brand-name medication when there's a generic available? If so, the prescription should specify "no substitutions" or something to that effect. Our plan changed and no longer covers the brand name if there's a generic available unless the doctor specifies that the brand name is required. A common example of this is with certain ADHD medications where the brand name has a proprietary release system that the generic medication does not have.

Also - where is she getting the medication from? Assuming she's on the same OTIP plan that I'm on, the deductible is only $2. If she's paying $3.99 that means that the dispensing fee is greater than the $11 (I think) that's covered. If you care about that extra $1.99 every time it might be worth finding a pharmacy with a lower fee or that is willing to reduce their fee. The pharmacy that's attached to my GP reduces their fee so that I pay nothing - they even cover the $2.
Oh that explains it very well! Thanks, my wife’s are all generics but my sons Concerta is not. I’m up in Palmerston and just have a small town pharmacy and they are around $15 a refill. Could save a bit going elsewhere but really not worth the travel I figure. Again thanks!
No One Goes to Palmerston Ontario
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Dec 27, 2013
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Redfisher wrote: Oh that explains it very well! Thanks, my wife’s are all generics but my sons Concerta is not. I’m up in Palmerston and just have a small town pharmacy and they are around $15 a refill. Could save a bit going elsewhere but really not worth the travel I figure. Again thanks!
Yeah, Concerta is what I was thinking of. They have a proprietary time-release mechanism built into the pill itself that the generic brands don't have. Let the doctor know and they'll know what to write on the script. As long as there is a medically necessary reason to use the brand name, the plan will cover it.
[OP]
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Feb 10, 2011
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OntEdTchr wrote: Yeah, Concerta is what I was thinking of. They have a proprietary time-release mechanism built into the pill itself that the generic brands don't have. Let the doctor know and they'll know what to write on the script. As long as there is a medically necessary reason to use the brand name, the plan will cover it.
Makes total sense! I’ll let the boys doctor know and get that fixed!
No One Goes to Palmerston Ontario
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Aug 9, 2020
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if you get the innovi cares pharmacy card from the pharmacist, (or you can sign up online), you can get brand name concert for generic price

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