Prescription Benefit Basics
With prescription drug prices driving a big chunk of healthcare costs, your prescription benefit card can be a pretty powerful income-protection tool. The challenge, as it turns out, is understanding how best to use it. Of course, the concept behind drug benefits is simple: They allow you to get discounted prices for medications. Beyond that, prescription coverage can get complex, and failing to navigate that complexity can mean paying more than you have to for prescriptions.
One big aspect of this complexity is what’s known as the Prescription Benefit Manager. Better known as PBMs, these are third-party players representing insurers, health plans and self-insured corporations in price negotiations with drug companies. With your plan, you basically pay whatever price your PBM has negotiated. Still, you can exert some control over costs by following three basic steps.
Know your plan. This might seem obvious, but a lot of people simply don’t know their plan deductibles, co-pays, out-of-pocket limits and so forth. Learn about your plan and make sure you’re paying what’s dictated by your coverage.
Learn about pricing factors. Your cost will, in part, be dictated by a formulary (the list of drugs your plan covers and at what rate) and tiers (a system that ranks payable amounts by factors such as whether you’re buying a name-brand drug or generic equivalent). While your care provider might prescribe a specific drug, check to see whether that drug is listed on your formulary and at what tier. You might save money if your provider substitutes a different version of the prescribed drug in order to get one on your formulary at a favorable tier.
Check into price-lowering options. While prescription prices might seem beyond your control, you can lower costs by considering four factors:
Basic options: As mentioned above, ask your provider to prescribe a lower-cost drug and ask if you can get a 90-day supply rather than the typical 30-day supply. Finally, many plans identify certain pharmacies as being “in-network” – choosing one of those pharmacies will lower your prices.
Discount cards and apps: Using your prescription benefit plan might not get you the lowest price. Check into the many discount cards and apps available, and ask your pharmacy to help you find the option offering the lowest price for individuals drugs.
Manufacturer support: If you need a specific, expensive drug, appealing to the manufacturer can sometimes get you a reduced price or even free medications.
Exceptions: Appeal to your insurer to see if it will make a price exception to reduce financial hardship.
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Tags: benefits, Prescriptions