Americans spend way more on their medications than people in any other country worldwide.
On average, Americans spend approximately $1,500 each year on their prescription medicines.
This is enough to make most Americans have to choose between medications and things like food or bills.
There is a way that you can save on the costs of your prescriptions through an affordable prescription drug insurance, though.
Read on to learn all about prescription medication insurance — how to get good insurance to pay for your medication, why you need it, and what it’s all about.
Typical health insurance coverage of medication
Most health insurance plans cover some medications, but not all.
This is especially true for those on Medicare.
For those on Medicare, there is a type of insurance for your medication called Part D.
This allows you to get many vaccines free of charge and limits the price that pharmacies can charge for certain approved medications, like insulin.
In some cases there is still a co-pay for you to receive your medications though.
As part of the new laws that are in effect in 2024 you will not have to pay a co-pay if your prescriptions reach a certain price, or you can get help if you are within a certain financial range.
Other types of insurance plans typically cover only a portion of the cost for your medications, leaving you to still pay out of pocket, on top of your co-pay.
How does it work?
To avoid having to pay extremely high out-of-pocket expenses for your medications, you should look for an insurance plan that offers prescription coverage.
This is often a stand-alone plan but can be attached to your health insurance.
Typically, your prescription medication insurance works by covering some or all of the costs of your medication.
Some plans make you pay a copay to get your coverage or require you to pay a certain amount before coverage kicks in (this is called a deductible).
Your health insurance plan is required to inform you of what medications they offer coverage for and the amount you will be responsible to pay for.
Your health insurance may cover more of the costs for generic medications than brand name ones.
They may also cover less of the cost for specialty medications, as well.
Most insurance has tiers or formularies that they classify prescriptions into, ranging from least to most expensive and including generic and brand name medications.
When you receive a prescription, you need to check your plan’s lists to see your out-of-pocket costs for it.
Some plans may also have utilization management to keep costs down, which requires things like:
- Info of why you need the medication
- Prior authorization — which may mean you need to try a certain medication first
- Or a limit on the quantity they will cover
Finding the best prescription medication insurance
When looking for the most affordable prescription drug insurance, do your research.
Ask family, friends, or even your doctor what plan they recommend.
Look at the plan’s tiers to see what prescriptions they cover and how much you would need to pay out of pocket.
Check if they have a deductible that you would have to meet before they begin to pay for your prescriptions or a copay.
See if they have utilization management and what it entails.
Shop around to find the plan that will fit your budget and cover most of the costs of your prescriptions.
