Before coming to work for McGohan Brabender, I spent three years working in retail pharmacy. That helped me gain a good understanding of pharmacy benefits. But for the majority of people without first-hand experience, pharmacy benefits can be confusing. If you don’t know how your benefits work, you may be missing out on potential savings.
Here are six things to know before you fill your next prescription:
Brand Name vs. Generic Drugs
Many brand name drugs have a generic equivalent on the market that is available at a much lower cost. The active ingredient in a generic drug will be the same as a brand name drug, meaning it treats you the same way the brand name drug would. For example, a patient taking brand name Prilosec for heartburn may decide to take generic omeprazole. Many drug manufacturers often produce the same medication, meaning there are competitive prices for dispensing their generic drug. Ask your pharmacist or doctor if there are generics available for you to try.
Many brand name drugs may have high copays associated with them. To help bring down those pricey copays, check whether the drug’s manufacturer has coupon cards available for use. Coupon cards are billed as a secondary payer to your insurance carrier. For generic medications that are not covered by your insurance, you can ask your pharmacist to bill a coupon card. Ask your pharmacist or physician if they have coupon cards available. Cards can also be found on the drug manufacturer’s website, on websites like goodrx.com, and on the back of AAA member cards.
Medications are categorized in different tiers based on factors such as the drug’s intention, wholesaler and manufacturer cost. Most generic medications will be classified in a lower tier, meaning you pay less than you would for the brand name drug. Check with your doctor to see whether you can take medications that may be classified in a lower tier than the medication(s) you are currently taking.
Filling at Preferred Pharmacies
Pharmacies are usually contracted with insurance carriers to be considered a “preferred” pharmacy. While you may be able to fill your prescription at a variety of pharmacies, it may be less expensive to fill at a specific chain. For example, your insurance carrier may pay for a 90-day supply of your maintenance medication at a drugstore, but pay more money toward filling this at a nearby grocery store. Your carrier can help you understand what pharmacies are preferred. Call the member services number on the back of your ID card.
Utilizing Mail Order Services
Some insurance companies prefer to fill medications for their members in their own facilities. While some people prefer to opt out of this service, mail order can save you money and time that you would have spent traveling to your local pharmacy.
Completing Prior Authorizations (PA)
When your medication is not covered by your insurance, it is possible you can have your doctor complete a prior authorization with your insurance carrier. Prior authorizations can take several days to complete and process with your insurance carrier, but if approved, can result in a significantly lower copay. Prior authorizations are commonly completed for both brand name and generic medications. It is important to note that prior authorizations do not always result in a paid claim.