ComPro – Prescription Drug Costs

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Prescription Drug Costs

Are you dealing with the high cost of prescription drugs? In June 2018, an article written by Kaiser Health News and published in USA Today identified the monthly costs of some of the most frequently advertised drugs.

Eliquis – $503   Humira – $5,846

Trulicity – $876   Keytruda – $8,369

Lyrica – $1,070   Cosentyx – $11,310

(Source: www.usatoday.com/story/news/politics/2018/06/06/price-check-top-10-most-advertised-drugs/676763002)

Health insurance plans that provide prescription drugs develop “formularies” that are a list of the medications that a plan will cover. This applies to medications that you purchase at a pharmacy or through a mail order service. This is true across all segments of the market—employer plans, individual health plans, Medicare, and other government healthcare programs. If your medication is not included on the formulary, it generally means that your health insurance plan will not contribute to the cost of the medicine and will not apply your cost toward the deductible on the policy.

A friend that uses an expensive medication to help with severe nerve pain recently found out that even though it was covered by her insurance plan in 2018, it won’t be covered in 2019.

So, what are your options?

  • If you haven’t already tried alternate medications, find out if a lower cost drug will work for you.
  • If your plan requires “step therapy” before approving the medicine that you want to use, then provide the history of other medications that you have tried.
  • If “prior authorization” is needed, ask your doctor to submit the needed information.
  • You and your doctor can work together to request an exception to the formulary. This requires you to provide documentation explaining why you need to use this particular medication. Each insurance company has a process. If your request is approved, it means that the prescription will be covered by your policy. It doesn’t mean that your cost will be low.
  • Talk to your doctor and pharmacist about programs that provide lower cost access to the medicine that you need.
  • Search online. Drug manufacturers usually offer the best cost-savings programs. Frequently, there is a copay or discount card that helps with the cost for a limited amount of time. All the medicines listed above offer savings programs on their website.

If you have questions about your prescription drug coverage, talk to ComPro.

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