If you have prescription coverage, odds are you have a formulary, which can save you a lot of money on prescription drugs.
What is a formulary?
A drug formulary is a list of prescription drugs (both generic and brand name) that are preferred by your health insurance plan. Your plan may only pay for medications that are on their “preferred” list, unless your healthcare provider talks with your health plan and gets prior approval.
Most insurance companies maintain formularies, or a list of drugs that they pay for as a plan benefit, usually using a tiered system. Less expensive drugs have the lowest co-pay (Tier 1), the most expensive drugs have the highest co-pay (Tier 3), and the remainder lie in between (Tier 2). This tier designation does not go strictly on retail price — insurance companies negotiate for discounts that sometimes may make a costlier drug preferred over a less costly one.
Formularies are organized along therapeutic classes. For example, they all contain several blood pressure pills, antibiotics and diabetic medications, though often only one mediation from each therapeutic sub-class.
How do I save money on prescription drugs with my formulary?
If your doctor chooses from your list of preferred drugs or formulary, it will save you money. How does your doctor know what to choose? In short, your doctor doesn’t… not unless they have access to your formulary or list of drugs covered by your insurance plan. Get two copies — bring one with you to every doctor visit. Have your doctor keep the other in your chart for reference.
Tier 1 drugs may not necessarily be your first choice. You may be intolerant of a certain drug, or perhaps unresponsive to it. You may be stable on a particular name brand prescription for years already and are therefore hesitant to make a change. Some medications require blood level monitoring, and levels may be more consistent with brand name medications. Switching to a generic may not save you money if you need to have your blood level checked more often.
Additional savings are available in the form of coupons or rebates from pharmaceutical companies, which may save you $20 to $50 off your co-pay, thereby lowering your out-of-pocket cost for a higher tiered drug to the same as that of a lower tiered medication.
So to sum it up… know your formulary and partner with your doctor to save money!