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  #21  
Old 31.10.2019, 22:00
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Re: Assura: Used wrong pharmacy

Just to be clear, is Assura saying they will not cover the medicine at all, or they won't pay the pharmacy directly?

I ask because my insurance also has an agreement with a specific pharmacy chain. I can fill a script anywhere, but if it's not at that chain I must pay out of pocket and request reimbursement. They will not pay a non-member pharmacy directly.
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Old 31.10.2019, 22:08
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Re: Assura: Used wrong pharmacy

Assura clearly get some kind of kick-back or deal from Sunstore. Also Sunstore charge no extra service fees on prescriptions which most other pharmacies do. I see Assura also has a collaboration with Toppharm (who do charge the fees), for one of their other offerings.
I had an Assura model which meant I had to go to Sunstore and it was a PITA so I switched to another model at not really any extra cost and have free choice.



I'm in a similar situation where docs gave me a prescription but it took some time to order the meds and when they arrived assura said they'd only pay for it via the hospital if the hospital used the assura supplier. So I get all the meds I need, or don't need, from the hospital but I have to pay for this initial pack from the pharmacy.
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  #23  
Old 31.10.2019, 22:09
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Re: Assura: Used wrong pharmacy

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AFAIK 0% discount on prescribed medicine for assura members, discount is on over the counter medicine or other products.
Category C, D and E. Those can be prescribed but such is not mandatory for buying them.

There is also no such thing as a list which dictates fixed prices for which medicines that need prescription go over the counter.

Surely the people who say such list does exist can come up with it, or provide a law/ruling that forces pharmacies to use these prices from such list.
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Old 31.10.2019, 22:10
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Re: Assura: Used wrong pharmacy

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AFAIK 0% discount on prescribed medicine for assura members, discount is on over the counter medicine or other products.
15% on generica
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  #25  
Old 31.10.2019, 22:38
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Re: Assura: Used wrong pharmacy

Out of interest, what sort of savings are to be had by going with one of these restricted plans? Talking saving hundreds per month? Tens per month?

We have free choice of doctors, hospitals, pharmacies, specialists..etc, don't need referrals, don't need to send in bills, can do anything online, in English.. We have low franchise and pay 900 / month including supplementaries like private room etc, family of 4 ..
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Old 01.11.2019, 06:49
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Re: Assura: Used wrong pharmacy

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Out of interest, what sort of savings are to be had by going with one of these restricted plans? Talking saving hundreds per month? Tens per month?

We have free choice of doctors, hospitals, pharmacies, specialists..etc, don't need referrals, don't need to send in bills, can do anything online, in English.. We have low franchise and pay 900 / month including supplementaries like private room etc, family of 4 ..
For me its a saving of 720CHF in year. 60 CHF a month.

So do you have the lowest franchise? 300 CHF?
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  #27  
Old 01.11.2019, 06:57
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Re: Assura: Used wrong pharmacy

https://www.comparis.ch/medikamente/default

"Prescription drugs
Prescription drugs can only be obtained with a doctor's prescription, so they are also referred to as prescription. The prices of prescription medicines are set by the Federal Office of Public Health (FOPH) and reviewed every three years. A prescription drug will be remunerated by the basic insurance if this was also set by the FOPH on the list of specialties (SL)"
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  #28  
Old 01.11.2019, 07:06
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Re: Assura: Used wrong pharmacy

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Total nonsense.

Assura members get a direct discount of up to 15% at SunStore, this would be illegal if prices are fixed.

Also SunStore is owned by Galenica which also owns Amavita, and together with Coop runs Coop Vitality and is in no way owned by Assura.

You are making up your own facts.



Dig a bit more
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  #29  
Old 01.11.2019, 07:18
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Re: Assura: Used wrong pharmacy

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Dig a bit more
15% on Generica only. Generica prices dont seem to be a fixed price
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  #30  
Old 01.11.2019, 07:44
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Re: Assura: Used wrong pharmacy

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Out of interest, what sort of savings are to be had by going with one of these restricted plans? Talking saving hundreds per month? Tens per month?

We have free choice of doctors, hospitals, pharmacies, specialists..etc, don't need referrals, don't need to send in bills, can do anything online, in English.. We have low franchise and pay 900 / month including supplementaries like private room etc, family of 4 ..
Is that subsidised by your employer, it sounds very cheap to me.
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  #31  
Old 01.11.2019, 07:47
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Re: Assura: Used wrong pharmacy

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Is that subsidised by your employer, it sounds very cheap to me.
Yes. We want to know which insurance company,which city,age,subsidized?,franchise amount, standard model or hausartzt. A few facts here would help!
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  #32  
Old 01.11.2019, 08:59
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Re: Assura: Used wrong pharmacy

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so so sorry to hear about your wife, and wish her all the best.

I'd phone or even go to Assura, with someone who speaks fluent French if you do not- and explain the genuine mistake and ask how you can find a way, exceptionally. They might charge an extra fee, but worth a try. Legally, they can insist on the terms of your contract with them - but they may well try to help due to circumstances. Happy to come and help, if required. I also have a close relatives at Assura I could ask for advice.

Bonne chance.
I want to thank everyone for the good advice and for all the well wishes. It's been a hard road for my wife since June this year with two operations and 15 weeks of chemo so far. But she has been an absolute trooper and the prognosis is optimistic.

I called Assura to explain the mistake and the advisor instructed me to write to explain the situation. I hope we can find a way. This is clearly 'user-error' navigating the healthcare mine field for the first time. It's obvious that we would have filled the prescription at the correct pharmacy and not elected to pay for the expensive prescription drug ourselves elsewhere. I am sure this is not the first time this has happened. It is somewhat frustrating that no one contacted us to tell us we were making such an error.

I will keep you informed of the outcome. And @Odile thank you for the offer of assistance. It is appreciated.
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  #33  
Old 01.11.2019, 09:14
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Re: Assura: Used wrong pharmacy

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I want to thank everyone for the good advice and for all the well wishes. It's been a hard road for my wife since June this year with two operations and 15 weeks of chemo so far. But she has been an absolute trooper and the prognosis is optimistic.

I called Assura to explain the mistake and the advisor instructed me to write to explain the situation. I hope we can find a way. This is clearly 'user-error' navigating the healthcare mine field for the first time. It's obvious that we would have filled the prescription at the correct pharmacy and not elected to pay for the expensive prescription drug ourselves elsewhere. I am sure this is not the first time this has happened. It is somewhat frustrating that no one contacted us to tell us we were making such an error.

I will keep you informed of the outcome. And @Odile thank you for the offer of assistance. It is appreciated.
It seems Assura is the only one the says you can only go to certain pharmacies to get medicines ( prescription) . And in Zürich there are only 4 pharmacies on their list.
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  #34  
Old 01.11.2019, 09:15
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Re: Assura: Used wrong pharmacy

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I want to thank everyone for the good advice and for all the well wishes. It's been a hard road for my wife since June this year with two operations and 15 weeks of chemo so far. But she has been an absolute trooper and the prognosis is optimistic.

I called Assura to explain the mistake and the advisor instructed me to write to explain the situation. I hope we can find a way. This is clearly 'user-error' navigating the healthcare mine field for the first time. It's obvious that we would have filled the prescription at the correct pharmacy and not elected to pay for the expensive prescription drug ourselves elsewhere. I am sure this is not the first time this has happened. It is somewhat frustrating that no one contacted us to tell us we were making such an error.

I will keep you informed of the outcome.
Of course it’s not the first the first time this has happened, they are strictly applying the rules and hoping that you will just accept it. Many people probably just pay and chalk it up to experience.
In most instances if you write and explain the situation in a calm way and explain that it was a genuine mistake they will make allowances, especially if you are new to the system and it is a first ‘offence’.

Good luck with everything and all the best for your wife and her treatment.
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  #35  
Old 01.11.2019, 09:22
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Re: Assura: Used wrong pharmacy

Assura offers a variety of models, one of which (and I assume that is the case for the OP here) requires you to obtain pharmaceutical products at recognized pharmacies, notably Sun-Store.
Sun-Store doesn't charge the extra fees that pharmacies are allowed to charge, for "verifying the prescription" and that obviously saves a few francs on every prescription.
I'm not sure the OP has much to stand on here. It's all very well taking on a health insurance model which is cheaper, but that has conditions tied to it, which weren't followed. You can certainly go and try and negotiate with Assura and see if you can get anything, but they aren't known for bending the rules.
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  #36  
Old 01.11.2019, 10:11
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Re: Assura: Used wrong pharmacy

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Is that subsidised by your employer, it sounds very cheap to me.
I'm rounding a little, it's maybe 930-940 of something but yes that's total, I actually only pay 750-760 with my employer subsidy.
And yes the insurer comes to our office each year so we probably have a bit of discount but I assume that only discounts the supplementary part, legally?
Same insurer for 7 years, I think that gets a few % off too.

i have a 300 deductable (becuause i had a planned operation this year), wife 1k, kids zero.
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  #37  
Old 01.11.2019, 11:55
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Re: Assura: Used wrong pharmacy

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Out of interest, what sort of savings are to be had by going with one of these restricted plans? Talking saving hundreds per month? Tens per month?

We have free choice of doctors, hospitals, pharmacies, specialists..etc, don't need referrals, don't need to send in bills, can do anything online, in English.. We have low franchise and pay 900 / month including supplementaries like private room etc, family of 4 ..
I don't know about monthly savings, but at least in our case it's a difference of whether you need to pay a big chunk of money up front. In OP's shoes, I would prefer the insurance to pay that 5K and bill me any co-pay or franchise as opposed to dropping that much cash on one medicine. I think my debit or credit card would even block such a transaction due to the high amount vs. daily limits.
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  #38  
Old 01.11.2019, 14:19
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Re: Assura: Used wrong pharmacy

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My wife is currently undergoing treatment for cancer and as part of that we received a prescription for quite expensive blood booster injections. Unfortunately we were not mindful of Assura's requirement to use only SunStore and we took the prescription to an Amavita who happily filled it and sent the justification direct to Assura. Assura are now refusing to pay for the prescription because we didn't use an approved pharmacy. We could be liable for around chf5000 as a result even though her basic franchise of chf2500 has been more than surpassed this year.

Does anyone have a similar experience and is there any way of resolving this? I will be writing to Assura to explain and will address the matter with the pharmacy also.
I assume you have the Pharmed model and not the Hausartzt

I suggest you change your franchise to 300CHF and change to the Hausartzt model.

https://www.assura.ch/de/produkte/gr...erung/hausarzt

with the Hausartz model one has no restriction with pharmacy

Last edited by omtatsat; 01.11.2019 at 15:09.
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  #39  
Old 01.11.2019, 15:53
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Re: Assura: Used wrong pharmacy

You'll find a list of prescription medicine prices (and some non prescription ones) here:


https://med.mymedi.ch/index


I've never been charged a different price by any pharmacy, but don't want to get involved in discussions about whether or not the prices are binding.


You'll find a list of pharmacies that don't charge additional fees for dispensing medicines here: (updated yearly)



https://www.konsumentenschutz.ch/medikamente-kaufen/
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  #40  
Old 29.11.2019, 11:34
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Re: Assura: Used wrong pharmacy

A bit of good news here. After writing to Assura to explain the situation they have agreed to extra-ordinarily honour the prescriptions obtained in the incorrect pharmacy.

Upon the advice of our oncologist we reduced her franchise for 2020 to the minimum.

Once again, I would like to thank everyone for their advice and well wishes. My wife finished her chemotherapy last week and we are looking forward to her recovery and continued care.
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