How to save on prescription drugs
Understanding how your coverage works can help you lower costs.
Posted June 3, 2015
As you are certainly well aware, health care costs have been rising, and prescription drugs are a major part of this increase.
The good news is that there are ways to save money on prescription medications, starting with simply paying attention to how your prescription drug coverage works. Like other health insurers, Fallon Health continuously negotiates pricing with drug suppliers, which helps hold down members’ out-of-pocket costs.
Here come the tiers
Our prescription drug formulary is a list of the drugs we cover for Fallon members, arranged into tiers: Tier 1 drugs have the lowest copayments, Tier 2 in the middle, and Tier 3 carrying the highest copayments.
- Tier 1 contains generic drugs, which have the same active ingredients and effects as brand-name drugs.
- Tier 2 contains cost-effective, preferred brand-name drugs.
- Tier 3 contains all other brand-name drugs, including newer and very expensive drugs.
Often, when a doctor recommends a Tier 3 drug, there’s another safe and effective option in a lower tier that could be used. Sometimes, though, the best choice for you won’t have a generic alternative. In this case, you can still save money. Fallon Health offers certain brand-name drugs, called preferred drugs, on Tier 2.
In some cases, there may even be an over-the-counter alternative that can be used. Certain drugs, such as proton pump inhibitors and allergy medications, were once prescription-only but are now available over the counter, as well.
Save money and time
Another great way to save is by taking advantage of our mail-order pharmacy service. Fallon Health members who take maintenance
medications—those taken regularly at the same dose for three months or more—can get up to a 90-day supply by mail for the cost of only two copayments. That’s a savings of up to 33%, plus the time and expense of going back and forth to the pharmacy.
Other ways to save
Be skeptical of drug commercials. They’re designed to make new medications sound as appealing as possible. But the newest drugs often aren’t good choices for everyone, and all their adverse effects may not yet have been discovered.
Keep track of your medications and store them as directed. Drugs that require refrigeration can be ruined by being stored in a warm environment. Depending on your insurance, you might not be able to get coverage for replacement of drugs that were misplaced or ruined.
Follow your doctor’s advice on whether a prescription drug is even necessary for your condition. If a drug is not really needed, it is useless at best, possibly harmful, and a waste of money. For example, taking antibiotics for a cold won’t make you healthier faster and could actually make you sicker.
Keep in mind that when you save on your prescriptions, your insurance company does as well, which helps hold down premiums for you and other members. Check out Pharmacy 101 to learn more.