No prescription gift cards for federal employees?

[LadyBeBop]

I work for the Federal Government. Most of my co-workers and I have health insurance through the Federal Employee Program. Pretty much the same as any other insurance program. We pay our premiums and our employers (the Government) pays the rest.

One of my co-workers have Blue Cross/Blue Shield through the Federal Employees program. Yesterday she tried to use a coupon at K-Mart...free gift card with a new or transferred prescription. The pharmacist on duty refused to accept the coupon. The coupon stated it could not be used for any government benefit program. And since we were federal employees, we were on a government benefit program.

My friend was upset. To her and me, a government benefit program means something like Medicare or the state medical cards for uninsured children. It does not mean insurance for government employees.

She took back the prescription order and will try at another K-Mart tonight. But what do y'all think about that? Are we not able to use government coupons, strictly because we are federal employees?

 

[SandrA9810]

I know at Target, the pharmacist said that the gift cards were not eligible if they were on medicare. Can't get something for nothing.

I had to pick up a new prescription for my aunt the other week. She's always gotten the gift cards in the past, so I knew she should get it. The girl that rang me up tossed in the coupon book, which I knew had the $10 GC coupon in the back. I asked, well aren't you going to give me the gift card? She went back and double checked on the computer to see that my aunt also had Humana on top of medicare.

That's when she told me, that if you're on a free program, you can't get it. But I would think that to be a bunch of bull if you're paying into your own medical insurance. You're not getting it for free. Has your friend tried the Target Pharmacies yet??

 

[ajh88]

I understand your frustration and I'm surprised that transfer coupons are not being honored as part of this regulation. Unfortunately, I don't know the entire history of this, but I have assumed it has something to do with any money from the federal government paying for prescriptions. I also have the same interpretation of "government assistance" (well, Medicaid - not Medicare part D - that can be expensive!), however that isn't the specific wording in most cases.

I copied the information below from the Advair website, but the wording is similar on nearly all prescription coupons and discount offers. I would check the coupon to see if it has this specific wording on it or not...if not, you could probably argue at store level. The problem for the pharmacy is that if they use a coupon that is deemed "against the rules" by the insurance company, they could get audited and lose a ton of money (I've seen it happen first-hand - not pretty).

To be eligible for a coupon:
In addition to fulfilling the eligibility requirements below, this coupon is valid only for your actual out-of-pocket costs relating to this prescription up to the dollar amount stated on the coupon. In order to be eligible for this offer: (a) you MUST be responsible for the cost, or a portion of the cost, of this prescription yourself, (b) your prescription MUST NOT be covered and/or reimbursed by a federal healthcare program, including Medicare or Medicaid, or by any similar federal or state program, including a state pharmaceutical assistance program, and (c) you MUST NOT be Medicare eligible and enrolled in an employer-sponsored health plan/prescription drug benefit program for retirees (i.e., you are eligible for Medicare Part D but receive a prescription drug benefit through a former employer). Further, if you are a resident of Massachusetts or Puerto Rico, this offer is valid only if you are paying the entire cost of the prescription yourself (i.e., your insurance does not cover any of the cost of your prescription).

ETA: I have never interpreted this regulation as not allowing people to get "something for nothing" as a technician may have stated. I think the vast majority of people realize that patients pay for Medicare part D out of pocket - it is more about the regulation of federal dollars. I'll need to do a little research to see what the origin of this restriction really is.

 

[sookie]

i also work for the fed too!! i ran into this just this week! i had to go pick up xopenex and advair for my child. there were coupons available, so i went to use them- and they said no! each copay was 65 bucks. it would have been a huge help!
i tried to argue that this was only eligible for like medicaid and medicare - which i pay - a LOT - for my gov insurance! but alas - it didn't work.

 

[susianew]

The law is if ANY federal money goes toward the cost of the prescription, pharmacies (or drug companies) cannot offer any incentive to fill a prescription. I can't remember the exact law, but it is part of the Fraud and Waste regulations, and I believe, carries a $10,000 fine. (But don't quote me.)
This applies not only medicare and medicaid, but also to federal employees AND even Tricare (military insurance).

The reason behind this is if Store X offers a $25 coupon with a new prescription and the customer has a $3 copay, they net $22 per fill of that prescription. BUT...the federal government has to pick up the remaining cost of the prescription, which could be over $100 per fill. (And maybe they're not even using that med anymore...they're just trying to make a buck.) So if Store X accepts coupons from people with federally sponsored insurance, they are considered to be enticing people to waste federal monies.

Every pharmacist I know hates these coupons...they encourage bad behavior (transferring scripts all over the place so no one has a complete list of what people are on to check for interactions) and it's no fun to tell the family of an active military member that we can't honor their coupon

Susan

 

[susianew]

The law is if ANY federal money goes toward the cost of the prescription, pharmacies (or drug companies) cannot offer any incentive to fill a prescription. I can't remember the exact law, but it is part of the Fraud and Waste regulations, and I believe, carries a $10,000 fine. (But don't quote me.)
This applies not only medicare and medicaid, but also to federal employees AND even Tricare (military insurance).

The reason behind this is if Store X offers a $25 coupon with a new prescription and the customer has a $3 copay, they net $22 per fill of that prescription. BUT...the federal government has to pick up the remaining cost of the prescription, which could be over $100 per fill. (And maybe they're not even using that med anymore...they're just trying to make a buck.) So if Store X accepts coupons from people with federally sponsored insurance, they are considered to be enticing people to waste federal monies.

Every pharmacist I know hates these coupons...they encourage bad behavior (transferring scripts all over the place so no one has a complete list of what people are on to check for interactions) and it's no fun to tell the family of an active military member that we can't honor their coupon

Susan

 

[MickeyMinnie1971]

Is this a new change? I haven't done this recently, but I have received gift cards from Target, Walgreens, and CVS using BCBS through federal governement.

 

[ajh88]

I'm guessing that dis-allowing the gift cards must be a new change - or new enforcement - or the result of a loophole closure - or something along those lines. I'm not as well versed in this as I could be because the pharmacy where I work does not participate in these gift card promotions at all (which actually makes me happy despite my budget tendencies!), but I'm guessing that either new regulations were passed to include these gift card offers OR a company got dinged (as in fined) for them and now all companies have started enforcing it. Just a guess though...

 

[LadyBeBop]

The law is if ANY federal money goes toward the cost of the prescription, pharmacies (or drug companies) cannot offer any incentive to fill a prescription. I can't remember the exact law, but it is part of the Fraud and Waste regulations, and I believe, carries a $10,000 fine. (But don't quote me.)
This applies not only medicare and medicaid, but also to federal employees AND even Tricare (military insurance).

The reason behind this is if Store X offers a $25 coupon with a new prescription and the customer has a $3 copay, they net $22 per fill of that prescription. BUT...the federal government has to pick up the remaining cost of the prescription, which could be over $100 per fill. (And maybe they're not even using that med anymore...they're just trying to make a buck.) So if Store X accepts coupons from people with federally sponsored insurance, they are considered to be enticing people to waste federal monies.

I understand what you're saying, Susan. But it also applies, even if we pay a good portion of the insurance? Just because the Federal Government pays the employee portion...as the employee?

 

[Leajess99]

The law is if ANY federal money goes toward the cost of the prescription, pharmacies (or drug companies) cannot offer any incentive to fill a prescription. I can't remember the exact law, but it is part of the Fraud and Waste regulations, and I believe, carries a $10,000 fine. (But don't quote me.)
This applies not only medicare and medicaid, but also to federal employees AND even Tricare (military insurance).

The reason behind this is if Store X offers a $25 coupon with a new prescription and the customer has a $3 copay, they net $22 per fill of that prescription. BUT...the federal government has to pick up the remaining cost of the prescription, which could be over $100 per fill. (And maybe they're not even using that med anymore...they're just trying to make a buck.) So if Store X accepts coupons from people with federally sponsored insurance, they are considered to be enticing people to waste federal monies.

Every pharmacist I know hates these coupons...they encourage bad behavior (transferring scripts all over the place so no one has a complete list of what people are on to check for interactions) and it's no fun to tell the family of an active military member that we can't honor their coupon
Susan

I have had the coupons denied as well as my kids used to have CHAMPVA as their primary insurance. It stunk because I still had a copay with the kids' medicines. Now their primary is a civilian insurance so we can use the coupons but I rarely do unless they are available at Target and I am heading that way anyway (nearest pharmacy is 45 miles away).

 

[msmayor]

Some of you folks may not realize that its not Blue Cross/Blue Shield, or some other 'insurance company' that is paying the benefits. The money to cover these costs is, in fact, federal money from the government.

They "self-insure", which means they are paying the money you don't. They pay the "employee" piece of the premium AND the difference between your copays and the contracted amount.

Insurance companies like BC/BS only handle the paperwork for self-insurers. That's it...

 

[OrangeCountyCommuter]

Some of you folks may not realize that its not Blue Cross/Blue Shield, or some other 'insurance company' that is paying the benefits. The money to cover these costs is, in fact, federal money from the government.

They "self-insure", which means they are paying the money you don't. They pay the "employee" piece of the premium AND the difference between your copays and the contracted amount.

Insurance companies like BC/BS only handle the paperwork for self-insurers. That's it...

For those of us in the industry... the regulations for "Federally funded" healthcare include all the UMPTEEN Goverement Agencies (Park Service, Dept of Labor, Treasury, FBI, etc....) So I can see why KMart said no. And as msmayor pointed out.. the Federal Goverment actually 'self insures" Blue Cross is just paying the bills for them.
Insurance is "benefit" pure and simple!

 

[Belle1962]

Some of you folks may not realize that its not Blue Cross/Blue Shield, or some other 'insurance company' that is paying the benefits. The money to cover these costs is, in fact, federal money from the government.

They "self-insure", which means they are paying the money you don't. They pay the "employee" piece of the premium AND the difference between your copays and the contracted amount.

Insurance companies like BC/BS only handle the paperwork for self-insurers. That's it...

I'm confused--what do you mean by "the Federal Government is paying the "employee piece" of the coverage"?

 

[Cindy B]

Makes me glad I'm not a fed employee anymore! However in my state, those transferring coupons or gift cards are not valid until you are over age 60 or 62. So I miss out on all the deals. Sure you can go to a neighboring state and get it filled but that is a huge hassle.

 

[SandrA9810]

I picked up an antibiotic med for my grandmother, cost was 4$ for the generic, and she still received the $10 gift card. So Target was pretty much paying me to fill it there.

 

[kaytieeldr]

Disagree. Welfare is a government benefit program. Fuel assistance is a government benefit program. Food stamps (or whatever they're called now - SNAP? - is a government benefit program. A typical employee benefit, simply because one happens to be employed by a government entity? NOT a government benefit program.

OP, have your coworker contact the Consumer Affairs Department in your state.

 

[sameyeyam]

There is a way that you can have federal insurance and still get the gift cards.

1. Always take the $4 prescription lists with you to the doctor. When he says you need a medication, take the lists out and ask if anything on the lists will work. Most likely they will find something off the list that will work.

2. If your co-pay is more then $4 (and most of them are!), tell the pharmacy that you don't want to use your insurance, but want to pay out of pocket for that prescription.

3. You then get the gift card for a new prescription.

Just because you have insurance doesn't mean you have to use it. I ALWAYS ask the pharmacist what the price of the medicine will be without the insurance. Sometimes the actual price is cheaper then your $10 or $20 copay. You would think they would say something, sometimes they do, but they don't always. Instead they just charge the higher copay.

 

[Swimalie]

I haven't used it in a while but the last time I transferred a prescription under my husband Fed Govt Insurance, I was able to get the gift card. It's not a federal benefit program. It's health insurance, just like private employers offer to their employees. Private employers pick up part of the tab, so does the govt. That's the only difference.

 

[mdsoccermom]

My husband is a federal employee. I don't know about gift cards, but I have always been able to use manufacturer rebates and coupons for our prescriptions. I go to a small neighborhood pharmacy, not a chain. Doubt that has anything to do with it, but you never know.

 

[OrangeCountyCommuter]

Disagree. Welfare is a government benefit program. Fuel assistance is a government benefit program. Food stamps (or whatever they're called now - SNAP? - is a government benefit program. A typical employee benefit, simply because one happens to be employed by a government entity? NOT a government benefit program.

OP, have your coworker contact the Consumer Affairs Department in your state.

State laws and "wants" are superseeded by the federal goverment. Sorry, but the US Goverment views ALL the 'healthcare' it funds as a federally funded benefit.

And when you interview for a job they discuss your "BENEFITS" which may include healthcare insurance.

Yes, people can use these cards. Probably they should not be allowed to... do I think the goverment will ever bother to "audit" and catch them... not anytime soon, but following the "letter of the law" it's iffy!