Welcome Let’s learn Tips to lower care costs Let’s review Your estimated cost Resources

Prescription Drugs and Formulary

Prescription drugs

Prescription drugs are medicines your doctor orders to help treat an illness or health problem you have.

There are 2 types of prescription drugs. Plans charge different amounts for each:

  • Brand name drugs: usually cost more

  • Generic drugs: usually cost less

You can ask your doctor about switching to a generic drug as a way to lower costs.

You may pay a copay, co-insurance, or the full amount, depending on your plan. Some plans have a deductible just for prescription drugs.

Formulary

The formulary is a list of the prescription drugs that a health insurance plan will cover. You can find it on the plan’s website.

This list divides drugs by tiers (levels) that identify the strength of the type of drug and the cost of the drug. Tier I is the lowest cost and Tier 4 is the highest cost. The formulary can change during the year, so a drug the plan was paying for might not be covered or might cost more. If this happens, ask your doctor if there is a similar drug that you plan will still cover.

“The insurance company could even tell us, for an expensive medicine that yes, that will be covered. This is how much it's gonna be.”

Special tips

Cancer patients and survivors may take many prescription drugs.

When you shop for an insurance plan:

  • Check the plan’s website to see if they cover the drugs you take.

  • Call the plan with a list of the drugs you take to see if they’re covered and what they cost.

  • Call your pharmacy and ask about different ways to buy your drugs, like getting three months of pills at a time. Or, sometimes buying your drugs from your pharmacy’s website can lower the cost.

  • Check to see if a different pharmacy has cheaper prices for the drugs you need.

  • Call the drug company and ask if they provide any help with costs of their drugs.

Go to our Resources page for programs that might help.

Go Back
Next