Drug Formularies Save Money!
A drug formulary is a list of the prescription drugs that your health insurance company has agreed to cover so that when you fill your prescription, you don’t pay the full price of the medication. In most cases, formularies are comprised of drugs that are the safest, most effective, and most affordable.
How Are Drug Formularies Determined?
The medications on your health insurance company’s formulary were chosen by a third-party panel of experts known as a pharmacy and therapeutics committee. Pharmacy and therapeutic committees are made up of doctors, nurses, and pharmacists. The committee meets regularly to discuss new drugs, safety data, the results of clinical trials, and doctors’ recommendations for new drugs that may be added to the formulary. For this reason, the formulary may evolve over time as better drugs hit the market or new safety data comes out.
The health insurance company determines what these drugs will cost its customers. In most cases, the health insurance company covers a greater portion of the cost of more affordable drugs, such as generics and inexpensive brand name drugs, giving customers an incentive to opt for these over more expensive options.
How Drug Formularies Work
Drug formularies are comprised of drug tiers. Some health insurance companies only divide their formularies into four tiers while others may have as many as five or six. The tier that your medication is in determines your portion of the drug cost.
In most cases, each tier is associated with a specific co-pay, and the lower the tier, the smaller your co-pay. For example, your health insurance company may cover almost all the cost of a generic medication that is on the first tier, but you may pay a significant portion of the cost of a third- or fourth-tier drug. Sometimes Tier 6 medication costs $0. You’ll have to verify by reviewing your health plan or speaking with your broker.
Using Your Health Insurance Company’s Drug Formulary to Save Money
How much you pay at the pharmacy counter depends on your insurance plan and whether your medication is on your health insurance company’s formulary. In some cases, your primary care physician may have knowledge of your formulary or can look it up to determine what would be the most inexpensive medications they could prescribe for you. Other times, your best bet is to bring a copy of your formulary with you to doctor’s office visits.
Occasionally, health insurance companies remove a drug from the formulary. If this happens, then your insurer should provide you with written notice. This gives you an opportunity to speak with your doctor about switching to a more cost-effective medication.
Finding a Health Insurance Company that Fits Your Needs With Nevada Insurance Enrollment
Every health insurance company has its own unique drug formulary. If you are receiving treatment for a condition and you purchase individual health insurance, then finding a health insurance company that covers your prescription can help you save a lot of money. At Nevada Insurance Enrollment, our health insurance agents can help you review your needs and find the health insurance plan that will provide the best coverage.
Recent Posts
Things Potentially NOT Covered By Your Health Insurance
To be fair, in recent years, health insurance companies have made strides towards transparency. If you have an ACA-compliant plan, there are many services that your health insurance is legally required to cover, taking some of the guesswork out of budgeting for health expenses.
Medical Loss Ratio
This Medical Loss Ratio states that when a family or individual buys a medical plan, 80% of every dollar collected and paid to an insurance company MUST pay medical claims/research. So that leaves the insurance company to pay ALL of their expenses with the remaining 20%. .20 cents on the dollar for their employees, buildings, broker costs, etc.
Why Does Health Insurance Have an Open Enrollment?
The Affordable Care Act / Obamacare, put specific enrollment periods in place to prevent people from only enrolling in health insurance when they were sick or needed surgery.
Health Insurance Options For Laid-Off WorkersRelated Articles:
♦ Health Insurance Options For Laid-Off Workers
♦ Can You Choose Between Medicaid or Obamacare for Health Insurance?
♦ What Is Covered By Obamacare?
♦ Telemedicine Benefits
Read More: Individual & Family Health Insurance
Search This Website
Most Popular Pages
By page visits (this month)
#1) Health Insurance Subsidy Chart
#2) Health Insurance
#3) Health Insurance WITH a Subsidy
#4) Insurance Blog
#5) Request a Quote
Top 5 Most Popular
By page visits (this month)
#1) Health Insurance Subsidy Chart
#2) Health Insurance
#3) Health Insurance WITH a Subsidy
#4) Insurance Blog Posts
#5) Request a Quote
Recent Posts
Affordable Care Act Pros and Cons: Will It Last?
While a lot of good has come from the law, there have been serious downsides as well, leaving many to wonder whether the ACA will stand the test of time or be repealed and replaced.
What is Covered By Obamacare?
Preventive services are covered under the Affordable Care Act at no cost to the insured. This means there is no co-payment or deductible. There are specific services provided for all adults and specific benefits provided to women and children.
What Happens If You Forget To Pay Your Premium By The Due Date?
Life happens, and while you should make every effort to pay your health insurance premium on time, health insurance plans generally will have grace periods. You may have a grace period of 30 days, or if your insurance plan is through Nevada Health Link (on-exchange), it may be up to 90 days.
Where To Go: Emergency Room or Urgent Care?
There are distinct differences between hospital emergency rooms and traditional urgent care centers, including the level of care that can be provided at each location.