Choosing the medication that’s right for you is up to you and your doctor. Most insurance companies can help by offering an extensive list of covered brand, generic, and specialty medications so you and your doctor can decide what’s best for you based on how well it works and how much it costs. Most drugs fall into one of four categories:
Generic Medications – Generic medications have the same active ingredients, dosage, and strength as their brand name counterparts. You will usually pay less for generic medications.
Preferred Brand Medications – Preferred brand medications will usually cost more than a generic, but may cost less than a non-preferred brand. When a generic drug is not available, choosing a preferred brand can be a lower cost option.
Non-preferred Brand Medications – Non-preferred brand medications generally have generic alternatives and/or one or more preferred brand options within the same drug class. You will usually pay more for non-preferred medications.
Specialty Medications – Often more expensive medications, high technology medications and self-administered injectable medicine that are not available under preferred or non-preferred brand levels.
So how do you use your medical plan to get the most benefit?
- Ask about generics and lower-cost alternative. Talk with your doctor or pharmacist about generic equivalents or other medicines that are similar to your current medicine. You may be able to switch your higher-cost brand-name medication to a lower-cost alternative, such as generic. In addition, most insurance companies offer medicine cost estimators on their sites where you can type in the name of your prescription and find alternatives.
- Get your medicines mailed to you. Think about using your insurance company’s mail-delivery pharmacy for medicines you take all the time. With mail order pharmacy, you can order up to a three-month supply of maintenance medicines or a one-month supply of specialty medicines, and have them mailed right to your door.
- Make sure you are using a Preferred Pharmacy with your insurance provider. Most insurance companies have in-network pharmacies that they have negotiated pricing deals with. Some may even have “preferred pharmacies” that cover medications under an even lower co-pay or price than other pharmacies. Use your insurance company’s website tools to find these pharmacies.
- Use discount cards from the medicine’s manufacturer. In many cases, especially with specialty medications, the manufacturer offers discount cards that lower the price of the medication. Just look up your medicines manufacturer and go to their website. In some cases, your insurance company has services that help you find these discounts as well.