For most people, cost and convenience are at the top of the list when filling a prescription. Don’t wait to get sticker shock at the pharmacy counter. Use the five tips below to learn now what’s covered under your pharmacy plan, and how much you’ll have to pay.
And to get the most value out of the rest of your benefits, check out:
1. Learn which drugs are covered.
Most health benefits plans have a formulary, or list of prescription drugs that are covered. Formularies provide different levels of coverage based on the drug's cost, effectiveness or other considerations (brand-name vs. generic, etc.). Health plans review and update their formularies, generally once a year, so be sure to check for changes.
Some plans may cover some preventive drugs and over-the-counter (OTC) medications at no cost to you when prescribed by your doctor. Call customer service and ask what’s available to you.
2. Check out mail order options.
If you take regular medications, often you can save money by using mail order. Your plan may even require it. Check your plan documents to find out. Mail order is convenient and saves you money; you just send the prescription to them and your medicine arrives on your doorstep without a trip to the pharmacy.
3. Know the cost before you go.
Some plans have online tools that tell you – before you fill a prescription – how much a drug will cost. Check it out. If you can’t find an online tool, call customer service and ask. It’s better to know before you are standing at the pharmacy counter. And if it’s too much, you can ask your doctor to consider another drug.
4. Are there steps in your coverage?
Were you prescribed a really expensive drug? Sometimes a plan requires you to first try less expensive drugs for your condition. If the generic or other brand does not work well, the plan then may cover the more expensive drug. Often people find the less expensive option works well. These steps help keep your insurance more affordable.
5. Not a prescription?
You can save money by paying for over-the-counter medications and health products like bandages or contact solution with a Flexible Spending Account. You’ll need a prescription from your doctor for the medicines, however, and you need to fill it at a pharmacy. Note that IRS rules don’t allow use of FSA funds for non-prescribed medications, including over-the-counter medications.