ZBL - Part 1

ZBL means Zero Balance Logic.  It's a pharmacy contracting term meaning members on a health plan will pay the lower of copay or U&C.  So what exactly does this mean?  Most people with pharmacy coverage will pay a fixed copay for prescription drugs.  A typical benefit design would be $10 for generic drugs, $30 for preferred brands, and $60 for non-preferred brands.  With ZBL off if you buy a drug that costs less than $10 you would pay the lower amount, not the full $10.  A good example is Hydrochlorothiazide, or HCT, a common blood pressure medication.  Under most plans this drug would cost around $3.  With ZBL turned on you would pay the full $10, not the $3.  The exception would be if the U&C (usual & customary) price was lower.  The U&C price is what a customer without insurance would pay.  Wal-mart $4 drugs are an example of U&C.  You would pay $4 regardless if you had insurance.  Why would any health plan use ZBL and force their employees to pay more for a drug than necessary?  That's a good question.