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Understanding your pharmacy benefits can save you money

December 30, 2019

Nearly 50 percent of Americans have used at least one prescription drug in the past month, according to recent statistics from the Centers for Disease Control and Prevention. That means millions of us may need a prescription to fight an infection or treat an illness or injury.

Knowing how to use your pharmacy benefits can help you get the medication you need at the lowest possible cost.

Use your network

“Just like you have a network of doctors you see, you have a network of pharmacies to fill prescriptions,” explains Kirsten Tiberg, pharmacy director at Blue Cross and Blue Shield of Minnesota. “When you choose a pharmacy in your network, you’ll get the drugs you need for the lowest possible price. If you fill prescriptions outside your network, you’ll pay more."

Check the drug list

Your plan has a list of drugs it covers, known as a formulary. It includes both brand-name and generic drugs. You’ll pay less for drugs on the list and pay more – even full price – for drugs that are not on the list. It can save a significant amount of money to check your plan to see what coverage, if any, you have for drugs that are not in your plan’s formulary.

“If the drugs you have been prescribed aren’t listed on your formulary, ask your health care provider for a similar drug your plan will cover,” says Tiberg. “And remember, formularies can change throughout the year, so be sure you’re looking at the most up-to-date information.”

Tiberg suggests other ways to save money when it comes to prescription drugs:

  • For drugs you take on a regular basis (such as blood pressure or diabetes medications), use a mail order pharmacy. Your prescriptions will be sent directly to you by mail and can sometimes even be automated, so you don’t have to keep reordering.
  •  If you find it difficult to manage the cost of your prescription drugs, ask your health care provider about alternatives that may cost less.
  •  Remember to always take your medication as directed. “Taking drugs only half the time or taking just half the dose to save money on the cost of prescriptions can put your health at serious risk and lead to much bigger bills down the road,” Tiberg says.

If you are a Blue Cross MN member, you can learn more about your pharmacy benefits by signing in on the member network or calling the number on the back of your member ID card.

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