insurance

You May Pay More for Your Prescription Drugs

If your health insurance plan dropped your drugs from their formulary, you still have options.

If your insurance plan covers prescription drugs, you may be in for sticker shock the next time you go to the pharmacy. Express Scripts and CVS Caremark, two large pharmacy benefit managers that provide drug coverage for many health plans, dropped about 90 drugs from their preferred formularies (the list of drugs they cover) in 2019.

These changes can affect people who have coverage through their employer, as well as people who buy an individual policy. Specifics vary, but many insurers adopt the pharmacy benefit managers’ preferred formularies for their own coverage. (The drug lists can be different for Medicare Part D. The Trump administration has proposed new rules for Medicare plans that would require PBMs that receive rebates from drug companies to pass on the savings to consumers.)

If several drugs are deemed effective at treating a specific disease, the pharmacy benefit manager typically negotiates with drug manufacturers and chooses the option that costs it the least. That could cause a drug you’re using to be dropped from its formulary. If your drug is dropped, ask your doctor if you can switch to an alternative. For example, Pradaxa, a blood thinner that was dropped from Express Scripts’ formulary, costs about $500 for a 30-day supply without insurance. But you may be able to switch to warfarin, a generic version of a different blood thinner, which may be covered by your insurance with a small co-pay.

Some drugs may be difficult to substitute if you’re in the middle of treatment, says Dan Johnson, of ScriptSave WellRX, which provides price comparisons and a discount card. In that case, your best option may be to work with your doctor to file an appeal with the plan.

The William J. Clinton Presidential Library in Little Rock.

K4-AHEAD.a.indd

Getty Images

Most Popular

Where's My Refund? How to Track Your Tax Refund Status
tax refunds

Where's My Refund? How to Track Your Tax Refund Status

If you're waiting for your tax refund, the IRS has an online tool that lets you track the status of your payment.
March 2, 2021
Where's My Stimulus Check? Use the IRS's "Get My Payment" Portal to Get an Answer
Coronavirus and Your Money

Where's My Stimulus Check? Use the IRS's "Get My Payment" Portal to Get an Answer

The IRS has an online tool that lets you track the status of your stimulus checks.
February 19, 2021
Your Guide to Roth Conversions
Special Report
Tax Breaks

Your Guide to Roth Conversions

A Kiplinger Special Report
February 25, 2021

Recommended

Protect Your Home From Nature's Wrath
Becoming a Homeowner

Protect Your Home From Nature's Wrath

Not all damage is covered by standard homeowners policies. Make sure you’re prepared before it’s too late.
March 4, 2021
Having the Money Talk with Your Parents, with Cameron Huddleston
Financial Planning for Alzheimer's

Having the Money Talk with Your Parents, with Cameron Huddleston

Managing your parents' finances can be a difficult situation. Doing so if you haven't laid down a plan for how to do it is worse.
March 2, 2021
8 Insurance Products You May Not Need
Financial Planning

8 Insurance Products You May Not Need

You may be paying for insurance, such as long-term disability or product warranties, that is potentially unnecessary.
February 26, 2021
Switch Accounts for a Better Yield?
Financial Planning

Switch Accounts for a Better Yield?

If your current account has a reliable history of strong yields, it might be worth sticking around.
February 23, 2021