In plan design, what characteristic may prescription drug benefits have that differs from medical benefits?

• A. They may have separate networks and cost-sharing.
• B. They always share the same network.
• C. They never require prior authorization.
• D. They have no cost-sharing.

Answer: (B)

Prescription drug benefits are often carved out from medical benefits, managed separately by a pharmacy benefits manager, and they frequently operate with their own network of pharmacies and its own form of cost-sharing. This separation allows distinct contracts, pricing structures, and formularies for drugs compared with those governing medical services. Because of that, it’s common for the drug benefit to have a different network and different copayments or coinsurance than the medical benefit.

The other ideas don’t fit as well. Drug benefits don’t always share the same network as medical benefits, and many plans require prior authorization for certain medications. Also, cost-sharing is a standard part of drug benefits for many plans, so saying there’s no cost-sharing isn’t accurate.