There are many things to know when it comes to getting the medicine you need. How much will it cost? Is there one that will work just as well but cost less? Does it matter where I go to get my prescription filled?
And these are just a few. But don’t worry. We have the answers and tools to help.
People don’t always understand what goes into how much you pay for a drug. You may think whatever your pharmacy says you owe for what your doctor prescribes is what you’re stuck with paying.
You may have more control over the cost you pay than you think. Here are some ways you can take charge of your drug costs.
Ask for a generic: Generic drugs may be just as effective as brand name drugs. If there is a generic available for a drug your doctor wants you to take, you may be able to try it first. If it doesn’t work well, then you may be able to switch to the brand name drug.
Generics are often cheaper than a brand name drug. In fact, generics can be as much as 85 percent less than brand name drugs. The U.S. Food and Drug Administration explains why generic drugs may be the best choice.
Compare prices: Just like grocery stores and gas stations, pharmacies can charge different prices. A prescription that costs $12 at one pharmacy may be just $4 at another. Pharmacy benefit manager Prime Therapeutics (Prime) makes sure you get the best price with the best variety of drugs to choose from for each health issue.
We also have certain pharmacies that work with us to keep costs as low as possible for our members. You can find the list of these network pharmacies by logging in to your Blue Access for MembersSM (BAMSM) account. After you log in, go to the My Coverage tab and click on Prescription Drugs.
If you have Prime as your pharmacy administrator, you can find network pharmacies by logging in to your account on MyPrime.com. And the drug price estimator on the MyPrime site can compare prices for you from the pharmacies in the Prime network. After you log in to MyPrime, click Find a Pharmacy and enter your location. Then you can click Select Medicines, type in the medicine name and pick the pharmacies you want to compare.
Check your drug list: The plan you have uses its own drug list. That means not every drug on the market is covered. Unfortunately, doctors don’t always check your drug list before they prescribe medicine. If a drug seems expensive when you go to have it filled, it could be that it isn’t on your drug list or may be in a higher payment tier.
You can see what is on your drug list by logging in to your BAM account or the MyPrime site. If it isn’t on the list, call your doctor’s office and ask them to prescribe a drug from your list. You have the right to use a lower cost drug for your condition that is just as effective if one is available.
One last thing: There may be limits or requirements placed on your medicines before they will be covered. These checks are put in place to make sure you are getting the right medication at the right dose for you. It may mean that your doctor will need to submit the drug for approval.Learn more about these special requirements at the pharmacy section of our website.
Sources: Why Do People Stop Taking Their Meds? Cost Is Just One Reason, NPR, Sept. 8, 2017; People Don’t Take Their Pills. Only One Thing Seems to Help, The New York Times, Dec. 11, 2017; Generic Drug Facts, U.S. Food and Drug Administration, 2018
*Prime Therapeutics, LLC, is a separate pharmacy benefit management company contracted by Blue Cross and Blue Shield of Montana (BCBSMT) to provide pharmacy benefit management and other related services. In addition, contracting pharmacies are contracted through Prime Therapeutics. The relationship between BCBSMT and contracting pharmacies is that of independent contractors. BCBSMT, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.
MyPrime.com is an online resource offered by Prime Therapeutics, LLC.