When Figuring A Prescription Plan, It's the Little Things That Matter
By Elie Harriett
February 17, 2016
If you are like most people, you want to get the costs of your prescription drugs down as much as possible. The coverage gap, or “donut hole,” is a period where co-pays on your drugs end temporarily, and you instead pay a percentage of retail costs on your drugs. Usually, this means the costs of your drugs increase for a time. It is the retail costs of the drug, NOT what you pay in co-pays, which determine if and/or when you enter that coverage gap. With a little care, you can easily identify the drugs that are going to cause you the most difficulty with costs before and in that gap. In this post, we’ll explain a few common things to watch out for.
- Look closely at the letters before or after your drug’s name. A drug with an “ER” (extended release) or “CR” (controlled release) after it’s name can do a lot to increase the overall retail cost of the drug. If the retail cost of this drug is unusually high, you may want to seek out your doctor’s advice as to whether or not you can safely take a version without those letters, if one is available.
- Some drugs have multiple names, which impact costs greatly. For example, many people take the blood pressure-lowering drug Metoprolol. But there are two versions: Metoptolol Tartrate, and Metoprolol Succinate. The retail costs of these drugs are very different. One shows up on many $4 drug lists, the other does not. One of those drugs might be covered by the plan as a preferred generic and the other might not be covered at all. It is important when figuring your prescriptions to make sure you get both names on the list.
- Tablets or Capsules? If both are available, the price can be very different between the two. A tablet is a powder that is compressed into pill form. A capsule has the ingredients held in a liquid-dissolving shell. Sometimes, a person cannot medically take one or the other, so there might be a good reason you are taking a more expensive version. Consult with your doctor if you have one of those drugs which is readily available in an alternate format for a lower price.
- How much do you take? One of the biggest cost errors we have to help people resolve is when they figure the wrong milligram amount. In many cases, plans will charge different co-pays for a person that takes 50mg of a drug than a person who takes 150mg of a drug. This can have a significant impact on overall drug costs. Also, 2 pills, 3 times a day can have a much higher cost than taking that pill one time, once a day. Make sure when figuring costs to get these counts accurate.
- Names matter. Do you take Toprol or Metoprolol? Synthroid or Levothyroxine? Lipitor or Atorvastatin? All of these brand drugs have a commonly prescribed generic equivalent. What’s more, the generics of these are very often $4 or less while the brand can be $100. Can you take the generic? Are you? If your doctor says you can safely take the generic, then the cost savings can be astronomical. If you are taking the generic, then calculate the costs of the generic drug only when looking at a prescription drug plan. If you put in the brand drug name unnecessarily, you might get a very different, and inaccurate, result in determining your drug costs.
Lastly, and most important: DO NOT RELY ON DRUG LISTS WHEN FIGURING YOUR DRUG PLAN!!! More often than not, the drug list you keep is wrong. Milligrams change, dosages change, you went from brand to generic, your doctor’s last Rx fill changed your drug to a combo drug, and you noticed none of it. A drug plan enrollment locks you in for an entire year. You do not want to lock yourself in a plan that does not cover your current drug, because you could be stuck with this problem for an entire year. I know that many people have a great deal of confidence in the accuracy of their lists, but I urge you to pull out the bottles anyway and use the information on them when trying to accurately get your drug costs. Five extra minutes could save a year’s worth of headaches.
Finding an accurate prescription drug plan is a difficult task, and for that reason we encourage you to seek out advice from a knowledgeable insurance advisor. If you live in Ohio, West Virginia, or Kentucky, please contact us for assistance in this, or any of your other insurance needs.
