With so many medications available today – and more and more people taking them – managing use, costs, and safety can be complex. As a reminder UnitedHealthcare’s Ancillary Charge and Step Therapy programs are both critical components of our prescription drug benefits, where the goal is to help improve compliance, savings and safety.
Ancillary Charge program
When a UnitedHealthcare and/or a Neighborhood Health Plan (NHP) member chooses to fill a brand medication when a lower-cost generic alternative is available, they will pay the cost difference between the brand and the generic plus their applicable Tier 1 copayment or coinsurance – an Ancillary Charge.
The Ancillary Charge program applies to Small Business (2-50) and encourages members to choose a lower-cost, generic medication, maintaining flexibility for members and ultimately lowering health care costs. The Ancillary charge applies to DAW 1 (medication substitution not allowed – must fill as physician prescribed) and DAW 2 (medication substitution allowed – patient requested product dispensed) prescriptions.
Step Therapy program
Most therapeutic classes of drugs have multiple medication options – and many of those are interchangeable. Although their clinical effectiveness is similar, the prices may vary widely.
UnitedHealthcare’s Step Therapy program applies to Small Business (2-99) and helps steer members to less expensive, but equally effective medications when they are available – before coverage is provided for a more costly alternative. Members get the treatment they need, usually at a lower cost, and our customers can save money. Most therapeutic classes have multiple medication options. Although their clinical effectiveness may be similar, their prices vary widely. While our tiering strategy and member education tools are effective in moving members to lower-cost alternatives in some cases, it does not work for everyone. Some individuals may not care about the high cost while others may not be aware of the lower cost options.
For more information on UnitedHealthcare’s Ancillary Charge Program or Step Therapy Program, please contact your Small Business Account representative.