Is Your Medication Covered?
You can find out by calling your insurance provider and asking for your plan’s Prescription Drug List (PDL), also referred to as a formulary. A Prescription Drug List will list the most commonly prescribed medications, both brand-name and generic, that are approved by the U.S. Food and Drug Administration (FDA), organized by drug tier.
Drug Tiers
| Tier 1 | Tier 2 | Tier 3 | Tier 4 |
|---|---|---|---|
| Most affordable drug options | Higher-priced generic drugs | More expensive brand-name drugs | Most expensive drug options |
| Often generic drugs | Lower-priced brand-name drugs | Often brand-name |
Generic Vs. Brand Name Drugs
A generic drug is a medication created to be the same as an existing approved brand-name drug in dosage form, safety, strength, route of administration, quality, and performance characteristics. Choosing a generic drug that is comparable to the brand-name drug you are prescribed is one way to save on your prescription medication.
Call your provider to find out if your prescription is covered before going to the pharmacy.
Prior Authorization
Call the number on the back of your insurance card and ask if your prescription requires prior authorization. If your doctor is in network, it is likely that they will call your provider for prior authorization for you. If you choose to see an out-of-network provider, you will be responsible for calling for prior authorization which could save you money on your prescription.
Prior authorization for prescription drugs may be required if it is;
· A brand-name drug that has a generic equivalent
· More expensive than alternative drugs of the same class
· Used for cosmetic reasons
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Prior Authorization
Prior Authorization is an approval from your health insurer or plan stating that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary.
Prescription Medication Savings
Are you frustrated with the cost of your prescription medication? Let’s take a look at 3 avenues for you to save money on that medication of yours and reduce your claims footprint.