How does the prescription discount benefit work?

Outlook Rx will provide you with a member identification card. Once your physician has written you a prescription simply take it to be filled at one of our participating pharmacy locations. While at the pharmacy, present your Outlook Rx discount identification card to the pharmacist/pharmacy technician. Your prescription claim information will then be submitted electronically, in real time, to our prescription processor. Once our processor receives this claim information, your eligibility information will be verified and your discount price calculated. Our processor will then send a response to the participating pharmacy indicating what is owed by you the member.

Will I save money on every prescription?

Outlook members are guaranteed to pay the lower of our contracted rate or the pharmacy’s standard price. In most cases, Outlook Rx’s contract rate will save members an average of 10% to 50% depending on the drug type and which pharmacy location the member chooses to fill the prescription. Our participating pharmacy network is comprised of different types of pharmacies. Consequently, each pharmacy has different buying habits when it comes to purchasing their drug inventory and setting their standard price. Therefore, there may be instances, particularly for certain heavily marketed brand name drugs that a particular pharmacy’s standard price is better than our contracted rate. In this instance the member will pay the price they would have paid even without the Outlook Rx benefit.

What is the difference between a brand drug and a generic drug?

There are two types of brand drugs; single source brand drugs and multi-source brand drugs. Single source brand drugs are those drugs that do not have a generic equivalent and are manufactured by the company who originated the drug. Single source brand drugs are protected by patent laws, allowing the original manufacturer to recoup the millions of dollars spent on the research and development process. Single source brand drugs are usually heavily marketed to physicians and consumers alike and are the most expensive drugs in the market place. Once this type of drug is introduced to the market it will be several years before the generic form of the drug is available. Common retail costs for a 30-day supply of a single source brand drug can range from $80 to $140 and higher. Multi-source brand drugs are less expensive than their single source counterpart. This is due to the fact that the patent protection is no longer in place and a generic form of the original drug is now being produced. Common retail costs for a multi-source drug can range from $30 to $50.

A generic drug is essentially a copy of the equivalent brand name drug. Although, the generic drug may look different than the brand name drug it must contain the same active ingredients. Before the FDA approves the generic drug, the manufacturer must prove that it contains the same active ingredients, meets the same standards of quality, strength, purity, identity, that it has the same rate and extent of absorption as the brand medication and is manufactured in compliance with current Good Manufacturing Practice regulations. Common retail costs for a 30-day supply of a generic drug can range from $10 to $30. However, it is important to note that newer single source generic drugs (former blockbuster brands; see example below) can see retail costs averaging from $50 to $80.

When a brand drug finally goes generic, how much money can I expect to save?

When patent protection is finally exhausted for a brand drug, in most cases one manufacturer is awarded a six-month exclusive right to produce the generic form of that particular brand drug. Initially, the generic form of this drug is considered a single source generic since there is only one manufacturer. Therefore, in these instances consumers can expect to save an average of 10% to 15% off of the original brand price. For example, if the original brand cost for a 30-day supply were $120 the new generic costs would be $102 to $108. Only when the exclusivity period expires and multiple manufacturers begin to produce the generic form of the drug will consumers see a 40% to 50% discount off of the original brand price. Note: Generic drugs, to be true equivalents of the brand name medications, must be approved by the FDA.

Can I use the Outlook Rx benefit if I already have prescription drug coverage?

Yes, if your primary coverage requires you to file a paper claim for prescription drug reimbursement. The Outlook Rx discount benefit will reduce your out of pocket expense by the amount of our discount. Once you have received the Outlook Rx discount benefit at our participating pharmacy location, simply file the claim with your primary provider for reimbursement. Or, if your current prescription drug coverage excludes certain prescribed medications, Outlook Rx may offer substantial savings on those medications.

If I forget my identification card and have my prescription filled can I file a claim with Outlook Rx for reimbursement?

No, Outlook Rx is NOT insurance. If you do not present your identification card at the time of service you will not receive the discount benefit. However, if you did leave your identification card at home or simply forgot to present your identification card, and you act within a reasonable time period (within 2 days of the fill), you may ask the participating pharmacy to submit the claim for processing and re-price for Outlook Rx’s discount. The pharmacy is not obligated to file the claim, however most pharmacies will.

How can I maximize my savings utilizing the Outlook Rx discount prescription drug benefit?

Although Outlook Rx members will realize savings for both brand and generic drugs, the most significant savings are realized on generic drugs. Since, in most cases, there are multiple sources for generic drugs, the negotiated discounts amongst our participating providers for these drugs are greater and yield a bigger savings to the member. Therefore, in order to maximize your savings, if a generic drug is available, always request your physician prescribe you the generic drug. Or at the time of filling your prescription, if the pharmacy asks if you would like the generic equivalent, elect to take the generic drug.