Do you recall a time when you went to pick up your prescription from your pharmacy only to be blown away at a high copay? I can assure you that your local pharmacy and pharmacist are not to blame. Your insurance company determines the copay amounts for medications. So what can you do to prevent being blown away again the future?
Drug Formulary
A drug formulary is a list of medications that are covered by insurance company. The goal of formulary is the efficient and appropriate use of medications. Commonly, medication formularies are tiered (categories of medications) with less expensive preferred drugs as level one and more expensive branded drugs being non-preferred. The copay will be the least amount for tier one (preferred medications) and most for non-preferred drugs. There are also often quantity limitations.
Knowing what medications are listed on your drug formulary is key BEFORE going to your physician, provider or pharmacy. Additionally, the name of your formulary is key as this allows you to access it online. There are a few various ways to find your formulary. Below are a couple of resources for obtaining your formulary.
- Check your employer’s website or human resources department
- Insurance card (phone number for Pharmacy Benefits Manager)
When reading your formulary, you will see the following items.
- Tiers: several various categories with at minimum tier one (or preferred) and non-preferred
- Drug classes under each tier
- Individual drugs listed under each drug class
It is important to remember that drug formularies are updated yearly so make sure to stay to up to date. Lastly, copays for each tier and yearly deductibles are vital information for budgeting and planning ahead for medical related expenses.
Cost Saving Tips
- Generics: These medications cost significantly less than brand name drugs. I highly recommend using generic over brand when possible. Below are some examples.
- Metformin (generic): Glucophage ® (brand)
- Pioglitazone (generic): Actos® (brand)
- Glimepiride (generic): Amaryl® (brand)
- Free diabetes medications: Publix offers metformin at no cost to the patient.
90 day supply: Check to see if copay is less for 90 day versus 30 day supply. Also, find out if you can get the 90 day supply from your local pharmacy.
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