Tiers, formularies, and generics. Learning the basics about prescription drug coverage can help cut confusion and cost.
Tip #1: Fill Prescriptions In-Network
- To use your prescription drug benefit, you must fill prescriptions at an in-network pharmacy. Each insurance carrier has their own network of pharmacies. Here are several quick links to find yours:
Blue Cross Blue Shield Pharmacy Locator
UnitedHealthcare Pharmacy Locator
- Some BCBS plans have a special Preferred Pharmacy Network. If you do, look for a Preferred Pharmacy. Use the filter at the top of the screen for in-network preferred pharmacies or look for the “P” next to the store. You may pay lower copays or co-insurance for your prescriptions at a Preferred Pharmacy.
Tip #2: Save Time with Mail Order Prescriptions
- Most insurance carriers offer a convenient way to have some prescriptions sent directly to your home. Orders can be completed online or over the phone.
- Not all prescriptions can be mail ordered. However, most “maintenance drugs” are available for this benefit. Each insurance carrier’s plans will have varying formularies as to which drug is considered available.
Tip #3: It’s ok to ask if there are less expensive options to your prescription.
- Not all prescription drugs are equal. But some are closer than others. There are brand name drugs that work in similar ways.
- Each insurance carrier publishes a drug list, for each set of plans they offer. Drugs on this list are approved for coverage in most cases. There are “tiers” on the list. Generally, drug copays or coinsurance follow the tiers, Tier 1 being least expensive, and higher tiers costing more. There may be a drug on a lower tier than what your doctor first prescribed. They may have a clinical reason for their choice, or they may agree to switch to another option. Ask your doctor directly, or ask your pharmacist to check with your doctor, if a change may be ok for you.
- To check if your prescription is covered, and if there might be less expensive options to ask about, find your drug list online 24/7.
- Some drugs also have generic versions. The U.S. Food and Drug Administration (FDA) approves generic drugs, which work just like the original brand name drugs at the same dose and strength but often cost less.
Tip #4: Find Manufacturer Discounts
- There are several websites that help individuals search for manufacturer coupons and other related discounts, which can gain you access to deep discounts for name brand prescriptions. One of these websites, offers free searching for your drugs is GoodRx.com
- A similar related website is Blink Health.
Do you have more questions about your coverage? Ask us a question!