The following plans are shown in a standardized format called a Summary of Benefits and Coverage (SBC) to help you compare your options. For more details about the Premier, Contribution, Saver, Local, and some other plans, see the Associate Benefits Book. Walmart Vision Center accepts most major insurance providers — but only for eye exams and in-store purchases. To see if your insurance is accepted, call your nearest location. According to the website, Walmart is an out-of-network provider for the following insurance companies. Zoloft Prices, Coupons and Patient Assistance Programs. Zoloft (sertraline) is a member of the selective serotonin reuptake inhibitors drug class and is commonly used for Depression, Major Depressive Disorder, Obsessive Compulsive Disorder, and others. Access your medical, dental, and vision options here, then choose what works best for you and your family. Everyone has unique health-care needs, preferences, and budgets, so.

The following plans are shown in a standardized format called a Summary of Benefits and Coverage (SBC) to help you compare your options.

For more details about the Premier, Contribution, Saver, Local, and some other plans, see the Associate Benefits Book. For more about HMO plans, contact your HMO provider. For a paper copy of any SBC, call People Services at 800-421-1362.

Premier, Contribution, Saver plans

Local plans

Walmart Insurance Copay Program

Health Net HMO plans

Kaiser Permanente HMO plans

Other HMO plans

eCommerce plans

Hawaii plans

Puerto Rico plans

Sleep Apnea SBC

SBC Glossary

• Glossary (PDF)

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What’s changing for 2021?

There are no major changes to the details of your plan for 2021, so the summary documents on this page apply to your current coverage. However, several 2020 plans are discontinued for 2021. Here are summaries for these plans:

Local plans

• Emory (PDF)
• Mercy—St. Louis (PDF)
• Mercy—Oklahoma (PDF)
• St. Luke's (PDF)
• Select Local Plan (PDF)

HMO plans

• BCN East SE (PDF)
• BCN West (PDF)
• Independent Health (PDF)
• UPMC Health Plan (PDF)

While clinical laboratories may not be directly affected by copay accumulators, anything that affects patients’ ability to pay for healthcare will likely impact lab revenues as well

Copay Health Insurance Plans

Here’s a new term and strategy that some big employers aredeploying in an attempt to control the choice of health benefits provided totheir employees. The term is “copay accumulator” and it is intended to offsetefforts by pharmaceutical companies to minimize what consumers must payout-of-pocket for expensive prescription drugs.

Clinical laboratory managers and pathologists will have a front row seat to watch this next round in the struggle between industry giants for control over how patients pay for drugs and treatment regimes.

Pharmaceutical companies on one side and health insurers and employers on the other side have played brinksmanship over medication copays for years. Now at the center of this struggle are copay accumulators, a relatively new feature of plans from insurers and pharmacy benefit managers (PBMs) on behalf of the large employers they serve.

More than 41-million Americans use copay accumulators, and about nine million use similar though limited copay maximizer programs, Zitter Health Insights, a New Jersey-based pharma and managed care consultancy firm, told Reuters.

Now, big employers are getting in on the game. Walmart(NYSE:WMT) and Home Depot (NYSE:HD) are among a growing number of companies usingcopay accumulators and copay maximizers to keep their healthcare costs down andencourage employees to seek lower-cost alternatives to expensive brandprescriptions (generic drugs).

About 25% of employers currently use such programs, and 50% of employers are anticipated to be doing so in just two more years, the National Business Group on Health told Reuters.

What Are CopayAccumulators and How Do They Work?

In response to popular drug company discount cards,insurance companies developed the “copay accumulator.” Here’s how it works.

Typically, patients’ insurance plan deductibles can be thousandsof dollars. Thus, even after plan discounts, patients often pay hundreds, eventhousands of dollars each month for prescribed medications. Insurance companiessee a beneficial side to this, stating the cost encourages patients to be awareof their medications and motivates them to try lower-cost non-brandedalternatives (generic drugs), all of which saves insurance plans money.

However, many patients with high-deductibles balk at payingthe high cost. They opt to not fill prescriptions, which costs pharmaceuticalcompanies money.

To encourage patients to fill prescriptions, drug companiesprovide discount cards to help defray the cost of the drugs. The differencebetween the discounted payment and the full price of the drug is paid by thepharmaceutical company. But these discount cards interfere with insurancecompanies’ ability to effectively track their enrollees’ drug usage, whichimpacts the payers’ bottom lines.

Thus, health insurance companies developed the copayaccumulator, which Dark Dailyexplained in, “CopayAccumulators Is a New Tactic in Struggle Between Payers and Pharma at Patients’Expense,” October 24, 2018.

When a patient uses a drug discount card at the point-of-sale, the sale is noted by the patient’s health insurer and the insurer’s copay accumulator program kicks in. It caps the total accumulated discount an enrollee can take for that medication and prevents any patient payments to apply toward the plan’s deductible. Once the drug company’s discount card threshold is reached, the patient bears the full cost of the drug, a ZS Associates Active Ingredient blog post explained.

Critics of copay accumulators point out that patients couldend up paying full price for extremely expensive prescriptions they previouslyaccessed with discount cards, while simultaneously making no progress towardfulfilling their insurance deductibles. Or, they will simply stop taking theirmedications altogether.

“A medication which previously cost $7 may suddenly cost hundreds or even thousands of dollars because the maximum amount of copay assistance from the [drug] manufacturer was reached,” noted Ken Majkowski, Pharm.D, Chief Pharmacy Officer at FamilyWize (a company that offers its own prescription savings programs), in a blog post. “Since the health plan will no longer allow the copay amounts to contribute to the patient’s deductible, the cost of the medication remains very high.”

Major Employers ImplementTheir Own Copay Accumulator Programs

Enter the next goliath into the fray—the large employer. Executivesat Walmart and Home Depot say discount drug coupons drive up healthcare costsand give their employees and their family members no incentive to explore lowercost alternatives, Reuters reported.

Walmart’s pharmacy benefits are managed by Express Scripts, a prescription benefit plan provider that fills millions of prescriptions annually, according to the company’s website. Meanwhile, Home Depot’s pharmacy benefits are operated by CVSHealth, which focuses on therapies for cystic fibrosis, hepatitis C, cancer, HIV, psoriasis, pulmonary arterial hypertension, and hyperlipidemia, Reuters noted.

Insurance AssociationsWeigh-In

Health insurance company representatives say the need for copay accumulators begins with the high price of pharmaceuticals. Insurers are not the only ones concerned about these costs. The American Hospital Association (AHA), the Federation of American Hospitals (FAH), and the American Society of Health-System Pharmacists (ASHP) recently released a report showing total drug spending per hospital admission increased by 18% between 2015 and 2017, and some drug categories rose more than 80%.

Walmart Insurance For Employees

University of Chicago National Opinion Research Center (NORC) compiled the data for the report.

Insurance Copays And Deductibles

“The bigger question is why do we need copay coupons at all? It’s very important to recognize the problem starts with the [drug] price. This is the real underlying problem,” Cathryn Donaldson, Director of Communications, America’s Health Insurance Plans (AHIP), told the Los Angeles Times.

In their blog post, ZS Associates advised drug companies to“push-back” on the copay accumulators. The Evanston, Ill.-based consultancyfirm recommends pharma executives change the way they run the discount cards—suchas paying rebates directly to patients instead of working through pharmacies.

Medical laboratory leaders need to be aware of programs,such as copay accumulators, and the associated issues that affect patients’ability to pay for their healthcare. Because large numbers of patients struggleto pay these high deductibles, it means clinical laboratories will be competingmore frequently with hospitals, physicians, imaging providers, and others toget patients to pay their lab test bills.

—Donna Marie Pocius

Walmart Insurance Services

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