I’m probably not telling you anything new, but wow — prescription drugs can be shockingly pricey!
Even after comparison-shopping for the best rate, downloading pharmacy discount cards, checking for generic alternatives and asking your clinician for samples, medication costs can easily strain even a careful budget.
Occasionally, when it feels like you’ve exhausted every option, someone offers one more tip to try.
Today that someone is Keith Speights from investment-advice site The Motley Fool.
Among the suggestions Speights lists to reduce your prescription expenses, he advises bringing your insurance company’s drug formulary with you to your next medical appointment.
“Ask your doctor whether the prescribed medication has substitutes, then consult the formulary to see which option will cost you the least,” he recommends.
That’s brilliant!
Except… I wasn’t entirely sure what he meant by that.
So I did a bit of digging, and in case you’re also fuzzy on what a drug formulary is, here’s what I uncovered.
A Drug Formu-What?
A drug formulary is essentially a compendium of prescription medicines covered by your health insurer or pharmacy benefit plan, according to HealthCare.gov.
Could it really be that straightforward?
Not exactly.
Just because a drug appears on a formulary doesn’t automatically mean you can stroll into a pharmacy with a prescription and leave with an affordable bottle of pills.
Oh, no, no, no.
The Reality of Drug Formularies
“The formulary system is intended to save money for both you and your insurer, but it’s often a hassle,” explains NerdWallet. “To get coverage for a costly drug you may first have to try a similar medication, or have your physician demonstrate you truly need it, and that process can take weeks.”
I’ve been through that exact scenario.
A while back, my doctor prescribed a medication that was clearly listed on my insurer’s drug formulary (or, as I jokingly call it, “the list thingy”).
I hurried to the pharmacy to pick it up and was stunned when they handed me a bill for $821.
When I rang up the insurance company to find out why the cost was so steep, they told me I needed to try a comparable drug for a month first to see if it would work.
If it didn’t, they said they would consider approving the original medication.
No amount of begging from me or intervention from my doctor changed their position, so I agreed to the alternative. Unsurprisingly, it didn’t perform as well, and eventually I switched back to my doctor’s first choice — which the insurer then approved.
Go figure.
The story didn’t stop there.
By the time I needed a refill, my insurer’s drug formulary had been updated and that medication was no longer covered.
Meanwhile the substitute I’d tried first now was. (Seriously?)
The price on that medication was $610.
Lesson learned: the list of medicines on a drug formulary isn’t fixed and can change at any time.
Where Can I Find My Insurer’s Drug Formulary?
Most insurers publish their drug formulary on their website. It might be a downloadable document or a searchable database.
If you can’t find the list online, call the number on your insurance card and they’ll provide you the formulary.
What If the Drug I Need Isn’t on the Formulary?
If the medication you require isn’t on the insurer’s list, it’s labeled “non-formulary” and your insurance usually won’t cover it.
There is one avenue you can pursue.
“If you and your clinician feel that the non-formulary drug is necessary, you’ll need to request an exception from your insurer based on your specific situation,” says SafeMedication.
If your insurer still refuses, consult your doctor and pharmacist. They may be aware of alternatives or strategies that could lower the cost.
When my insurer pulled the formulary switcheroo mentioned earlier, my pharmacist discovered a prescription card on the manufacturer’s site that reduced the final cost to $108.
Still a sizable outlay, to be sure, but not the $600-plus it had been.
Another helpful resource to consider when confronting steep prescription prices is a prescription discount card, which can sometimes bring down the retail charge significantly.
Expensive prescriptions are a powerful incentive to stay as healthy as possible for as long as you can — and to be proactive about exploring every available cost-saving option.
Jordan Tate is a staff writer at Savinly. High medication prices are one of the main reasons she does everything she can to keep herself healthy.
