Many people get a prescription from their physician and take it to the pharmacy to get filled, only to discover that their copayment is much higher than they thought it would be.
Why?
Different Types of Insurance Coverage
Many insurance plans have different levels of coverage for different medications, and most companies list what medications are paid for at what level under their formulary list (a list of medicinal substances, formulas and product usages that prices tend to be based on). Medications that are listed on the formulary are usually covered to some extent by the insurance company.
Generic Vs. Brand-Name
Typically, generic medications on the formulary will cost less than their formulary brand-name counterparts. Non-formulary medications tend to be the most expensive because very often, the insurance company will not pay for medications that are not on the list, and if they do, only a very small portion of the cost is covered.
Ask Your Insurance Provider…
Insurance companies will provide patients and practitioners with a formulary list if requested, which can help take some of the guesswork out of estimating prescription costs.
By Dr. Crystal Riley, BDO Pharmacy Expert
A graduate of the Howard University School of Pharmacy, Dr. Crystal A. Riley has spent the majority of her career involved in drug information services for not only healthcare organizations and practitioners, but for patients as well. While her career has shifted towards researching healthcare policy and quality standards, Dr. Riley still actively seeks opportunities to keep patients informed and aware of medication-related issues to help improve their overall quality of life.
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