AHIP Practice Exam

What should Ms. Edwards consider when filling her prescriptions at non-network pharmacies?

1. There will be no additional costs compared to in-network pharmacies.

2. The cost will likely be higher than at in-network pharmacies.

3. Non-network pharmacies will not fill her prescriptions.

4. She cannot fill prescriptions unless in-network.

The correct answer is: The cost will likely be higher than at in-network pharmacies.

When Ms. Edwards fills her prescriptions at non-network pharmacies, she should be aware that the cost will likely be higher than at in-network pharmacies. This is because health plans that have a network of pharmacies typically negotiate lower prices with those pharmacies, which means that when a beneficiary opts for a non-network pharmacy, they often lose out on those negotiated rates. As a result, individuals may have to pay a higher share of the total cost when using non-network services. In addition, many health insurance plans might have specific co-payments or coinsurance rates for services received from non-network providers, which tend to be less favorable than those for in-network providers. This financial aspect is crucial for Ms. Edwards to consider as it directly affects her out-of-pocket expenses for medications.