You are responsible for knowing what drugs are on your plan’s formulary. When you enroll in a health plan, you will receive a copy of the drug formulary, or the list of generic and brand name drugs that are covered by your insurance plan. If you need a prescription, talk with your health care provider about prescribing a generic, which has a higher likelihood of being covered by your health insurance. If your doctor prescribes a drug that isn’t covered by your formulary, talk with your pharmacist to see if there are alternate medications that are covered by your insurance. Together, you, your doctor and pharmacist can determine what’s best for you.
Some health insurance plans cover over-the-counter medications, if your doctor prescribes them. In many cases, over-the-counter medications cost less than the price of a comparable prescription because you don’t have to pay a prescription co-pay or co-insurance. The price of over-the-counter medications varies a lot, so check with your local pharmacies to see where you can purchase them at the lowest price. If you have a high-deductible health plan with a health savings account or a flexible spending plan, you may be able to offset your out-of-pocket costs by using those funds to pay for over-the-counter medications.
Review your drug formulary to see the prescription drugs, both generic and brand-name, that are covered by your health insurance plan. If a drug you have been prescribed is not covered, contact your provider, pharmacist and health insurance company to see if there is a generic drug or an alternate medication that you can use.
Generic drugs are usually cheaper than brand-name drugs. Generic drugs are similar to the brand-name product in dosage, strength, usage, quality, and performance but aren’t advertised like brand name drugs.