individual’s responsibility. (U.S. Centers for Medicare & Medicaid Services, 2012) A2A. Coverage of Medications Switzerland’s basic insurance covers a list of medications found under Pharmaceutical Specialties. These medications must be prescribed by a doctor, and are subjected to a 10% co-pay. If switching from a generic brand to a name brand, the co-pay then increases to 20%. All medications not found on this list are to be paid out of the individual’s pockets. A supplemental insurance may be able to account for some of these costs if you have it. (Moneyland Magazine, 2019) In the United States, most insurances cover a certain list of medications as well. This list is called a formulary. Prescription drug coverage has three groups. The first group is prescription coverage before you meet your deductible, this usually means there is cost*sharing resulting in a small co-pay. Group two is prescription coverage after one has met their deductible for the year which is hard to meet depending on how that insurance plan’s deductible is. Lastly, group three is a special separate insurance coverage outside of medical insurance that is coverage solely for prescription drugs. A tier system is also used to determine the cost of a drug or its co-pay. Tier one is only generic drugs. Tier two are preferred name brand drugs. Tier three is non-preferred name brand drugs, and Tier four is costly drugs associated with serious medical conditions. These tiers are in place to promote cost effectiveness to consumers. It also states some insurance companies in the United States may not cover certain medications. (EHealth Insurance, 2018) A2B. Referral to See a Specialist In Switzerland, citizens have free choice of doctor. They can go see a specialist directly. However, normally, they see a general practitioner first, and if the general practitioner cannot treat the ailment then they are referred to a specialist who can.
(Interpharma Newsletter, 2019) The referral process to see a specialist in the United States varies depending on what medical coverage you have. For example, some insurance plans have health maintenance organizations or HMOs, and one would need a referral from a primary care physician to see a specialist, and limits the choice of specialist. Some insurance plans are provider preferred organizations or PPOs, which allow patients to have a wider more direct access to specialists. Specialists also retain the right to refuse Medicaid or uninsured patients due to limited safety net programs for specialty care.
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- Spring '19