Four Ways to Get the Most Out of Your Pharmacy Benefits
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Published on May 04, 2021

pharmacist helping man with prescription

Four Ways to Get the Most Out of Your Pharmacy Benefits

When it comes to choosing or using health insurance, we often think of doctor visits or possible hospitalization. However, there may be more to your benefits than you realize — including prescription medications.

First of all, make sure you understand your health insurance coverage for prescriptions, and make sure your pharmacy has your most up-to-date insurance information on file. Then look to your local pharmacy.

Melissa Goff, Assistant Vice President of Retail Pharmacy and Innovation at Avera, offers tips about how to get the best bang for your buck at the pharmacy.

Choose Generic Whenever You Can

“Your biggest money-saving move is asking your doctor for the generic version of a medication,” said Goff.

Brand names cost more because of the research and development that went into making the drug. After a five- to 10-year exclusivity period to recoup the cost of creating the drug, a generic version can be made and approved by the Food and Drug Administration.

Generic medications are interchangeable with brand names; they have to be just as safe and effective to be approved by the FDA.

“Even if a generic version doesn’t exist for the brand name drug your doctor is prescribing, always ask if there is a generic option that will be just as effective in treating your condition,” said Goff.

Check the Cash Price for Prescriptions

You can also pay cash for prescriptions, but why do that if you have insurance? Some prescriptions’ cash price is actually lower than your typical pharmacy co-pay. Some generic medications used for common illnesses may have a lower cash price, so it’s important to be mindful of this option.

For example, prednisone is a corticosteroid that treats inflammation, and its cash price is only a few dollars.

If you’re an Avera Health Plans member, this logic is already built into your health plan, meaning you’ll be charged the lowest price automatically.

Understand Tiered Drug Formularies

Tiered drug formularies go back to the co-pay amount a patient pays at the pharmacy. There are different levels of drug categories that your health plan determines for prescription drugs.

Prices of prescriptions rise as you go up the tiers. The cheapest option, generic, is on the bottom. Then brand-name drugs, which will include “preferred” and the more expensive “non-preferred” drugs. Specialty medications are found near the top.

“Most insurances provide member portals where you can find out which tier your medication falls in and what your expected co-pay should be,” said Goff. “Bring that information to your doctor’s appointment so they can be informed of what some lower cost options may be depending on your prescription drug plan.”

Choose a Quality Pharmacy

Getting the most out of your pharmacy care is also choosing quality services. A local pharmacy offers a more personal touch that a larger, mail-order company may not.

In fact, you may be most comfortable getting prescriptions from a pharmacy connected with the hospital or clinic at which your provider is affiliated. For example, if you received care from an Avera provider, the pharmacist from Avera Pharmacy can access your medical record or follow up with your provider if there is a concern.

“Consider your pharmacist as a last line of defense. Our job is to ensure your medication will be safe and effective based on your specific medical history and other medications you may be taking,” said Goff. “Having direct access to the medical record as a part of the care team ensures that our pharmacists are able to do just that.”

A local pharmacy may offer many of the services you can get with a larger company. For instance, ask if your pharmacy has an app to order refills or transfer medications online, and offers mail delivery. In addition, you could save time and money by syncing all of your prescriptions to be picked up on the same day every month.

Learn more about prescription benefits by talking to your health insurance provider.

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Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values.

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