Have you ever stood in line at a pharmacy and marveled at the countless number of drugs sitting on shelves behind the counter? It seems like there’s a drug — sometimes more than one — for every health condition.
For the last 20 years, I’ve cared for family members who take a mix of prescription drugs. My 19-year-old son was diagnosed with attention deficit hyperactivity disorder at a very young age, and we tried several drugs before we found the right one for him. And my live-in elderly mother-in-law? Let’s just say she has complex health issues and her own shelf of revolving drugs.
So I know firsthand how frustrating it can be to find the right medication and balance the monthly tab. The drug companies are always coming out with something new, leading us to hope that somehow it’s better than the last drug. But I’ve found that new doesn’t necessarily mean better. Just different, and often times more expensive.
So if you’re aiming to stay healthy and keep your drug costs down, you likely have options when it comes to your medication and your prescription drug coverage. It’s no secret that health plans have lower copays for generic drugs and higher copays (or no coverage) for brand-name drugs when there are lower cost options. In these instances, the generic or lower cost alternative has the same active ingredients and the Food & Drug Administration stamp of approval. It’s what tells us, “This drug is proven to work.” It’s one way to help keep health care more affordable. Your doctor can always request an exception to this rule when the generic drugs you’ve tried just aren’t right for you.
I’ve been fortunate to have health insurance most of my life, and I’ve learned some things along the way.
Your coverage and cost for drugs may differ depending on which health plan you have. But all plans will cover some form of a drug that is “medically necessary” to treat your condition.
Tip: Start with a generic when it’s available. Your costs will be less, and it’s likely covered.
Some drugs are not covered unless you’ve tried a less expensive drug first, and/or your doctor has an authorization approved by your insurance company. Avoid surprises and delays at the pharmacy by checking ahead of time.
Tip: Check your plan’s medication guide for requirements like an authorization or “step therapy.”
You can also talk to your doctor’s office when you get a prescription.
Which pharmacy you go to can make a difference. In today’s cost-conscious world, health plans may require that you use certain pharmacies for covered medication or supplies.
Tip: Check the online provider directory for pharmacies included in your plan’s network. For specialty drugs and medical equipment, there are often exclusive supplier networks. This means you’ll use one or two main companies for specialty drugs or medical equipment.
A little planning can go a long way when you need a prescription. Me? I log in to my online account – even at the doctor’s office – to look up a drug in my medication guide (otherwise called a formulary) or to find a participating pharmacy. My health plan representatives have also explained ways to save money on my mother-in-law’s prescriptions. Remember, it never hurts to ask!
Michelle Steffen is part of the team at Florida Blue. You can meet with team members in person at the Florida Blue Center in Winter Park Village. The Florida Blue team is available year-round with the goal of helping people in nearby communities achieve better health. They are able to assist with purchasing Marketplace, Medicare or other individual insurance plans, answer questions for any Florida Blue member about their plan, including those with insurance through their employer, and offer free health and wellness support such as classes, seminars, screenings and health coaching. Find out more at FloridaBlue.com