Among those prescribed, many rely on reduced pricing, available through their health insurance plan. While most prescription drug users are “safe”, and purchase medications covered under a carrier’s pharmaceutical formulary list, there are most definitely exceptions. Many enroll in plans without first considering whether or not a necessary medication is covered… Or even worse, enroll in a plan featuring reduced pricing for their medication only to have their plan’s formulary list changed: Forcing them to either pay a huge tab to continue receiving the drug or change their drug or health plan to afford to continue to purchase the prescription.
There are many factors that play into these situations, but a primary driver is this: It’s an ongoing battle between drug companies trying to make as much money as possible, and insurers who don’t want to pay exorbitant prices.
While there’s no easy way to navigate this world in all scenarios, here are a few hints to help you get the prescriptions you need, without breaking the bank:
1. Ask for generic alternatives from your doctor.
For some, name brand medication is the only effective option. For others, (many others), generic meds are a huge opportunity to save money, while accomplishing the exact same result.
We encourage our clients to have an open conversation with their doctor to explore any and all possible medications to save money. Generic drugs can be just as effective while saving a bundle.
2. Pay Cash
Did you know that cash pricing for many medications can be LESS expensive than going through the carrier and receiving their contracted rate? Strange, but true.
Before filling your next prescription, be sure to ask your pharmacist what the uninsured/cash price for that medication might be.
3. Ask for a discount program.
Rx discount programs have been gaining a lot of momentum in recent years. Ask your broker, employer, or even your pharmacist what the best discount program would be for your medication. Some members have reported big savings simply making this request at the pharmacist counter, as some of the more frequently used drugs become very familiar to the pharmacists filling the prescriptions – including the most effective ways to save.
4. File a grievance or request an exception with the carrier.
Carriers will sometimes facilitate requests by members to cover, in some way, a drug off of their formulary list. In particular, if you or your employee are unable to find an alternative to a certain specialty or name-brand drug, this could be cause for review.
To submit a request to your carrier, feel free to use the following links:
5. Pursue a holistic alternative, when possible.
We can’t bring up accessing medication without mentioning the alternative: Always pursue holistic health and wellness whenever possible. Healthy eating (low sugar, low processed foods etc…), excercise, and overall life balance are always preferable to simply taking a pill. When possible, take a pause and consider how you’re eating and using your time to think through possible ways to improve your health.