Generic Prescription Drug at
2, 2006: The $4 generic
drug plan at Wal-Mart Stores Inc. has arrived in California with
dozens of drugs priced at $9. The world's largest retailer said Friday
that 55 different drugs will be sold for $9 in California and eight
other states to conform with "loss leader" statutes.
The Sacramento Bee -
The drugs include a wide range of antibiotics, heart pills, diabetes
drugs and anti-inflammatory medicines. The reason for the $9 price:
The California code forbids anyone from selling something below cost
"for the purpose of injuring competitors or destroying
Wal-Mart doesn't believe it was charging below cost for the drugs in
question, said spokesman Kevin Gardner. But California and other
states, including Minnesota and Pennsylvania, calculate costs
differently than Wal-Mart does, and the $4 price was deemed too low
for those drugs, he said.
"We had to have a second-tier price," he said.
For simplicity's sake, Wal-Mart priced all 55 drugs at $9 high enough
to steer clear of the law in those nine states but low enough so it
"still saves customers money," Gardner said. Officials at
Target Corp., which also has rolled out a $4 pricing plan to match
Wal-Mart, couldn't be reached for comment.
Wal-Mart's $4 initiative was launched in Florida two months ago with
great fanfare and has gradually expanded to the rest of Wal-Mart's
territories. It reached California this week. The plan covers 331
different drugs. The prices are for 30-day supplies at typical
dosages, the company says.
Analysts believe the program could boost business at Wal-Mart, whose
sales have stagnated recently, while also triggering a substantial
Maximum: How it works?
maximum is a cap on how much you have to pay for your individual
or family’s covered medical expenses in a calendar year. After you
reach the out-of-pocket maximum, the plan essentially pays 100% of all
remaining covered expenses for that year.
Not all plans
include counting the same requirements towards the maximum. Coinsurance
is routinely included in the maximum out of pocket requirement, while
co-payments and the Deductible
are typically excluded. The out-of-pocket
maximum is specified in the Carrier’s Summary
of Benefits sheet.
maximums usually do not include:
- Expenses that are not
covered by the plan.
- Any extra costs
incurred for not following procedures.
- Charges over the
maximums allowed by the plan.
- Outpatient mental
health services over the maximum amount allowed under the plan.
- Amounts above the
eligible or allowable charges.
- Office Visit
- Prescription drug
Co-payments and Coinsurance: What are the differences?
annual deductible is the amount you are responsible for under the
medical insurance plan before the insurance carrier will begin to pay.
There is a deductible for an individual, as well as for any covered
family members. The most a family will pay in deductibles is
limited to three times the individual deductible. Many plans waive the Deductibles for office visits,
prescription drugs, and emergency room services.
are charged and paid at the time you receive certain types of
services, such as office visits, prescription drugs, and emergency
room services. These charges do not apply to the out-of-pocket
maximum. Deductibles are usually waived when there is a co-payment.
is the percentage of each claim above the deductible that you pay.
If the coinsurance is 20 percent, you pay for the deductible plus 20%
of the covered expenses until your annual out-of-pocket maximum is
met. Your Coinsurance percentage will be determined by the
plan you select, the type of service you receive, as well as whether
the service is received from an in-network or an out-of-network (if