Paying for medications can be a significant burden for families, especially when children have ongoing medical problems which require prescriptions. This article is intended to help you manage your costs.
Most insurance plans come with a "formulary
" for covered medications. A drug formulary is a list of prescription drugs, both generic and brand name, that are preferred by your health plan. Your health plan may only pay for medications that are on this "preferred" list. This formulary gets changed periodically as the insurance company negotiates drug costs with either manufacturers directly, or third parties called "pharmacy benefits managers." While our office has access to some of this information through our electronic medical record, often families have access to more up-to-date preferred medications list than we do.
What can you do to help? If you have access to your insurance formulary, bring it with you to office visits and let us use it to guide you to the most cost effective medications and prevent you from getting "sticker shock" at the pharmacy pick-up window.
It seems absolutely crazy, but there are times when it's actually cheaper for you to NOT use your insurance to pay for medications. For example, your copay for a generic prescription may be $20. However, the drug really only costs $8 if you pay cash. In Pennsylvania, the patient must ask the pharmacist for this information, they cannot suggest that you pay the lower cash price.
What can you do? Every time you pick up a medication at the pharmacy, before you sign or pay for it, ask the pharmacist if it would be cheaper to pay cash then process it through your insurance.
It often surprises families that medications costs can vary greatly between local pharmacies, but for some drugs it can be significant between two different pharmacies. How can you learn pricing differentials? There is a company called GoodRx
which has a website and phone app that you can use to compare pricing. In addition, they offer coupons if you are paying the cash price.
What can you do? Download GoodRx to your phone. Ask us what medications we are prescribing and look up where it might be cheapest for you before we send to the pharmacy. When you get there, pull up the GoodRx coupon and ask the pharmacist, "Would it be cheaper for me to pay for this through my insurance, or paying the cash price with this GoodRx coupon?"
For families on chronic medications, be sure to inquire from your insurance or your pharmacist whether obtaining at 3 month supply of medication would save you money. Often mail-order medications are the cheapest (but you need to make sure that we are not going to change the medication or dosing during that 90 day period). You may be able to eliminate at least one of the three month copays if you get a 90 day supply from your local pharmacy.
We look forward to partnering with you to keep your medication costs as low as possible.