Co-op Connections Card
Fergus Electric’s co-op connections card is a money-saving tool we’re proud to offer our membership. The primary advantage of this card is to obtain discounts on prescription drugs. Lewistown’s three pharmacies honor the card along with pharmacies in Roundup, Billings and Great Falls.
To find out which pharmacies are part of the plan go to www.locateproviders.com. At these sites, providers are located by zip code and distance from the zip code.
In addition to locating providers for prescription drugs, you will find providers for dental and vision services. There are no providers in Lewistown. However, there are several in Billings and Great Falls. Everyone in the family may use the same card an unlimited number of times. For additional cards and key fobs or to replace a lost card call 406-538-3465.
Other uses for the card include discount coupons and links for online shopping. Find these at www.connections.coop.
Co-op Connections® Program
Q. I have insurance, why do I need the Co-op Connections Card?
A. The premise of the pharmacy discount feature of the Cop-op Connections Program is that the member will receive the lowest price on prescriptions available on that day - the pharmacy’sretail price or the negotiated discount price, whichever is lower. With insurance, you will payyour co-pay amount no matter what the pharmacy currently charges for the medication.However, there may be times the discounted price through your Co-op Connections Card will be lower than your co-pay. We recommend you present your Co-op Connections Card as well as your insurance card at the pharmacy to make sure you get the best price available. Thisprogram will also help you obtain lower prices on medications that may be consideredexperimental or lifestyle – these are often not covered by insurance.
Q. Can the Co-op Connections pharmacy benefit be used in conjunction with myinsurance?
A. No, the Co-op Connections Card cannot be used with insurance. However, we do encourage members to have the pharmacist process the Co-op Connections Card and the insurance card to see which will provide the lowest price.
Q. How does the Co-op Connections pharmacy discount work with my high deductibleinsurance plan?
A. Consumers without health insurance are accustomed to shopping around for the best deal,but those with health insurance often assume their co-payment insulates them from the need tocompare drug prices. That may no longer be true now that the Co-op Connections Card offersdiscounts at over 60,000 pharmacies across the nation. The Co-op Connections Card providesaverage discounts of 15% off the usual and customary price for brand drugs and 47% off theprice of generics (which account for roughly two-thirds of all prescriptions). In the case of highdeductible health plans, where less than 10% of participants reach their deductible, this isespecially true. Be sure to present your Co-op Connections Card as well as your insurance card at the pharmacy to make sure you get the best price available.
Q. How does the pharmacist know how much to charge?
A. When a member presents any card, whether insurance or discount, the pharmacist will putthe information into their computer and also put in their retail price for the medication. Thisinformation is sent to the processor who will sort through the pharmacies various contracts andagreements and send back the amount the pharmacy has agreed to take for that particularmedication, as well as the price the member will need to pay at the time of service. For example, if a pharmacy is selling a generic drug for $4 but their contracted rate with the Co-opConnections Program is $7, the system will tell the pharmacist to charge $4. With insured plans, if a customer had a co-pay of $15, they would pay $15 regardless of the pharmacy’s retail rate.
Q. I was surprised by a processing fee for each prescription filled. Why would I use theCo-op Connections Program if I am charged each time?
A. In order for a pharmacy to accept any plan, insurance or discount, the pharmacy contractswith a claims processor. The pharmacist must use a processor to determine the amount aconsumer or insurance company will need to pay. The discounted price with the Co-opConnections Card is the same amount as what the pharmacist gets paid as a reimbursement from an insurance carrier. However, the processor charges for the use of their system, hence the processing fee. The processing fee is a usual practice for both discount and insured business. The difference is how the money flows. When a pharmacist receives their reimbursement back from the insurance company, the processing fee has already been deducted and the pharmacy receives a net amount. Since there is no claim involved in the discount process the processing fee needs to be collected by the processor directly from the pharmacy. The member pays the amount that includes the cost of the drug and the dispensing/processing fee. This processing fee will vary from drug to drug and pharmacy to pharmacy, depending on how the pharmacy contracted with the processor. Each pharmacy location or chain signs agreements with network processors and these fees are outlined in those agreements. Again, the difference is that under the discount program the dispensing/processing fee needs to be collected from the pharmacy.
Q. Who sets the prices for the prescriptions – the pharmacy, HealthTrans or NewBenefits? How do pharmacies get repaid for the difference between the discount theyoffer and the cost of the medicines?
A. The price for the prescriptions is based on a pre-negotiated contract with the processor(HealthTrans). The member will receive the negotiated price or the pharmacy’s standard retailrate (usual and customary rate), whichever is lower. The pharmacist adjudicates the claim atthe time of service to determine the price to charge the member on that day. The pharmacy isgetting paid the negotiated discounted rate, which is the same or a little higher than the ratethey have agreed to accept for insurance plans. There is no reimbursement to the pharmacybecause they are getting paid the agreed upon rate by the member at the point of service. Theprices are based on the following formula – Average Wholesale Price minus X% plus processing fee. The processor negotiates with pharmacies for a broad range of reimbursements including traditional insurance plans, worker's compensation, government programs and cash discount plans. There are times when a pharmacy will be selling a drug for lower than the industry standard Average Wholesale Price, like the current trend of $4 generics. In this case the negotiated price may be higher than the retail price. The customer will pay the lower price.
Q. Can I use the Co-op Connections Card in conjunction with Medicare?
A. You may use the Co-op Connections Card during your deductible period or while in thecoverage gap (doughnut hole). In some cases, a network pharmacy may accept the Co-opConnections Card or offer another cash price discount so that you can pay less for aprescription than your plan's negotiated price. This is considered a one-time "lower cash" orspecial price. If you are able to obtain a cash discount to pay an amount that's lower than yourplan's price, you will need to send your receipt to your Medicare drug plan. This ensures thatyour plan will count the amount you paid toward your out-of-pocket costs.