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How to save money at the pharmacy counter

Christopher Snowbeck, Star Tribune on

Published in Home and Consumer News

The first step for most people trying to handle drug costs is to understand the details of their insurance.

Medications are typically assigned to one of three categories — generic, brand or specialty — and then listed on a formulary that specifies which drugs the insurance covers. Patients pay more or less out-of-pocket depending on the formulary tier where a covered drug lands.

Tier 1 drugs are often called "preferred generic" medicines and have the lowest copays. "Non-preferred" generics follow in tier 2. From there, out-of-pocket spending generally increases as patients access "preferred brand" drugs in tier 3, "non-preferred brands" in tier 4 and specialty medicines in tier 5.

In higher tiers, "co-insurance" fees, which typically cause more pocketbook pain, can replace copays. So using generics when possible is one way to save.

Another tip is to stick with in-network pharmacies, since copays and co-insurance usually are higher when you go out-of-network. Finally, patients usually pay less when receiving a 90-day supply of drugs, often via a mail-order pharmacy.

All these details can vary by health plan, of course, so check your own plan documents.


"You need to understand your plan's benefits … to understand what drugs are covered and how they're covered," said Patrick Mitsch, a vice president for pharmacy at UCare, a Minneapolis-based health plan.

If out-of-pocket costs through the health plan are too high with a particular medication, Mitsch said, patients should ask their pharmacist and/or doctor if there's an alternative drug with comparable efficacy that has better coverage. When there's no alternative for a recommended drug that's not on the formulary, he said, patients might ask their insurer for a special authorization.

In some cases, health care providers are aware of or can help patients access special programs that can help with high costs, said Jesse Breidenbach, vice president of pharmacy at Sanford Health, a South Dakota-based health system.

"I would say almost all the time, there's a path toward getting to a point where the medication becomes affordable, maybe at little or no out-of-pocket cost," Breidenbach said.


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