Pay BillPrescription drugs can be an important part of managing your health. Understanding your drug benefits can help you work with your doctor to choose effective, affordable drugs to manage your out-of-pocket costs.
Are my drugs covered?
When your doctor prescribes a medication, it is important to know if it is covered by your plan.
View your covered drugs by looking at your plan’s formulary. A formulary is a complete list of medications that your plan covers. Like a restaurant menu, the formulary is arranged by categories to make it easier to use.
The formulary contains both covered brand name and generic drugs. The drugs are selected based on safety, unique qualities, how well they work, and cost.
Some members will find the name of their plan’s formulary on their member ID card, but not all plans include this information on the card. Speak with a RedShirt at Member Services to ask which formulary your plan uses, or to get help with drug coverage questions.
Independent Health uses a tiered system to help you determine the most affordable drugs. The tier for each drug is listed on your formulary. Tier 1 drugs have the lowest cost to members. Cost can increase as the tier increases.
Your formulary also includes a key, like on a map, which contains helpful information for understanding your pharmacy benefits.
Find the Independent Health formularies on our website. However, some members may find their formularies on the Pharmacy Benefits Dimensions website, a subsidiary of Independent Health.
Need help finding your formulary online? Contact Member Services.
What are my options if my drug isn’t covered or is too expensive?
There could be a medication under a different name that can provide similar clinical benefits at a lower cost. Talk with your doctor to review your options, which might include the following:
Ask for a Formulary Product.
If your drug is not covered (not on the formulary), share your formulary with your doctor and discuss the use of a formulary drug. An alternative might be on the formulary that is proven to be just as effective and safe but less costly or may not require prior authorization. In almost every situation, the cost-share of a formulary drug will cost you less than a non-formulary drug.
Consider a generic medication.
Generic drugs can often save you money. Ask if there is a generic version of your brand name drug.
A brand name drug is the name given by the original manufacturer of the drug. These companies invest in research and development of the drug and have conducted costly studies to test safety and effectiveness. These drugs are usually patented and can be expensive.
Once the patent expires for a brand name drug, a generic version of the drug may become available. A generic drug contains the same active ingredient as the brand name drug and also requires FDA approval. But the generic drug may have different inactive ingredients, color, shape, or size.
BRAND vs. GENERIC *
cost estimate per month
Consider a Different Drug.
Not all brand name drugs have generics. However, there could be a medication, under a different name, or in a different category, that can provide similar clinical benefits at a lower cost.
Drug vs. Therapeutic Alternative*
cost estimate per month
Shop Around.
Just like other goods and services we buy, prescription drugs can have different costs at different pharmacies. Investing some time to compare costs might save you money.
If you are concerned about drug costs, call or visit other pharmacies that are convenient for you. The pharmacy staff will be able to tell you the out-of-pocket cost of your drug(s) based on your plan.
If you decide to switch pharmacies to take advantage of any cost savings, you will need to ask your provider to send a prescription to the new pharmacy.
Switch all your prescriptions if you take more than one drug. It is important that your new pharmacy has a complete list of your medications for health and safety reasons.
Contact Member Services if you need assistance.
* Drug costs shown are estimates for informational purposes only and may change daily. Talk with a pharmacist for specific costs that apply to you.