Save on prescriptions with our new prescription drug search feature


One of the most common questions we get is how to determine which health insurance plans will offer the best coverage for certain prescriptions. This year, we’ve launched a new prescription drug search feature that shows drug prices under each plan, side by side. Before, it was a wild goose chase. Now, it’s an opportunity to save on your prescriptions and make better healthcare decisions. 

When deciding on a health plan, you should also consider the medications you take on a regular basis. Not the one-off antibiotics for your kid’s ear infection. We’re talking about the $700 excema cream your child needs. Or the migraine medicine that costs $1,800 for only eight pills. A formulary can help you with that. By reviewing different formularies, you can pick a health plan that covers your medications. Additionally, you can choose a plan that has your drugs listed on their lower tiers. 

We’ve put together this blog to explain how our prescription drug search feature works, how it can benefit you as you choose a health plan, and the basic ins and outs of the prescription drug world.

It’s no secret that prescription drugs are expensive. In fact, prescriptions in the US cost 2.54 times more than in other countries. 

Here’s a few quick prescription drug facts to bring the point home. 

  • The average American spends $1,200 a year on prescriptions
  • There are more than 20,000 prescription drugs that are approved for marketing (FDA, 2020).
  • About 66% of U.S. adults take prescription drugs (Health Policy Institute, 2021).
  • About 46% of U.S. adults have taken a prescription drug in the past 30 days (CDC, 2019).
  • The leading drug classes in the U.S. are antihypertensives, pain relievers, and mental health drugs (Statista, 2021). 

Source: SingleCare

The RAND study found that prices for unbranded generic drugs—which account for 84% of drugs sold in the United States by volume but only 12% of U.S. spending—are slightly lower in the United States than in most other nations. That means that brand name prescription drugs are what drives the cost in the U.S. 

Luckily, Congress is trying to fix that. 

But in the meantime, we’ve launched a new prescription drug search tool to ensure you get the best coverage for your medications. We believe the more you know about your prescription drug coverage, the better equipped you will be to take charge of your health and make good healthcare decision.

Let’s start with some quick prescriptions 101 so we are all on the same page. 

What is a drug formulary?

A formulary is a list of generic and brand name prescription drugs covered by your health plan. Your health plan may only help you pay for the drugs listed on its formulary. It’s their way of providing a wide range of effective medications at the lowest possible cost.

You may be asked to pay a co-pay of $5, $10, $20, or more, depending on the drug. Some drugs are covered at 100%, making your copay $0. You may also be asked to pay a percentage of a brand-name drug listed on the formulary, making your out-of-pocket cost much higher.

If you’re shopping for a new health insurance plan, you can typically find a link to the formulary on the Summary of Benefits and Charges (SBC).

If the data is available from our vendor, Take Command will provide the formulary in the details section on our platform.

How do tiers work? 

Your health plan’s formulary is divided into three or four categories. These categories are called tiers. Drugs are placed in tiers based on the type of drug: generic, preferred brand, non-preferred brand, and specialty.

Here’s what typical formulary tiers look like:

  • Tier 1: Drugs are usually generics and have the lowest copays.
  • Tier 2: Drugs will cost you more than tier 1 medications. They include non-preferred generics and brand-name medications.
  • Tier 3: Includes generics, preferred brands, and non-preferred brands. Your out-of-pocket price for these drugs will be higher than tiers 1 and 2. Your health plan may place a drug in tier 3 if it’s new or if there’s a similar drug on a lower tier.
  • Tier 4: Includes generics, preferred brands, non-preferred brands, and specialty drugs. Specialty medications treat rare or serious medical conditions. Your out-of-pocket cost will be highest in tier 4.

Some health plans have different numbers of tiers, but across the board, drugs in lower tiers will cost less and those in higher tiers will cost more. Take a close look at your insurance company’s formularies for each of their plans. A company may list a drug in tier 1 in one plan, but in tier 2 in another plan.

Pro tip: Don’t assume a tier 1 drug for a certain insurance company will be listed as a tier 1 drug for all insurance companies. You may find the same drug on different tiers from one insurance provider to another.

 

How are the formularies/tiers created and why do they change?

Typically, a team of medical professionals approves the drugs on a health plan’s formulary based on safety, quality, and cost-effectiveness. The team is made up of pharmacists and physicians who review new and existing medications.

Sometimes health plans choose not to cover a prescription drug. They do this if:

  • The drug has a generic version.
  • The drug is considered less effective than other, similar drugs.
  • The drug is as effective as other, similar drugs but costs much more.

Health plans update their formularies every year, but they also make changes throughout the year. These changes occur when a new drug becomes available or when the FDA decides a drug is harmful.

 

About Take Command’s prescription search feature 

Does sorting through drug formularies sound like fun? We didn’t think so. That’s why we created an easy way for you to compare plans side by side to see which coverage option is best for your prescriptions. 

You will add the prescriptions you regularly take and then in the “Details” section you will be shown the tiers. By using the comparison tool, you can also see tiers in different plans and from difference insurance companies.

How to use our prescription search feature

When starting the “Shop for Plans” portion of the onboarding process, you will have the option to “Add Your Prescriptions” as shown in the image below.

 

 

Clicking this option will bring up the prescription tool that will let you search from 20,000 prescription options that are available in the United States. You will simply search your Prescription by name and then select it.

Important note: Be sure you select the correct strength and dosage, as well.

 

We recommend that you list out all your ongoing prescription needs as well as the specific amounts that accompany them.

Once you have added your prescriptions successfully, you will have a message displayed at the top of the screen confirming they have been added.

Click APPLY and wait patiently for it to load (15 to 30 second wait is normal! It’s doing a lot of work!)

 

 

When you click the “VIEW DETAILS” under “CHOOSE PLAN,” you will be able to see more of the specifics regarding your prescriptions and what the specific plan offers.

 

And that’s it! We’re happy to bring another element to our shopping experience that is even more tailored to you and your needs.

Disclaimer: Take Command has regular updates to the drug data shown in the prescription search tool, but since it changes year to year and changes with new drugs hitting the market, it’s wise to double check with your carrier on coverage. 

 

Let’s jump in to a few more questions we hear about existing health plans and prescriptions. 

Where can I find my existing plan’s formulary?

If you’re already enrolled in a plan, you can find your formulary on your health insurer’s website. You must know the name of your plan to check the formulary that applies to you. Look for your plan’s name on your insurance card. If you can’t find the formulary online, call and ask the insurer to send you a copy either by postal mail or email.

 

Can my healthcare provider access my formulary?

Yes and no. Many health plans share their formularies with healthcare providers. Others don’t, leaving it up to you to take your prescription needs into your own hands.

Here’s what you can do:

  • Discuss with your doctor. 
  • Share your formulary with your physician.
  • Ask for a prescription from your list that best meets your treatment needs.
  • Ask about generics. Explore the generics or tier 1 and tier 2 drugs on your formulary with your doctor to find an effective drug that costs less.

 

What if my medication is not on my plan’s formulary?

Taking steps to get your plan to cover a drug is easier than you think. Every insurer has an “exceptions process.” You will need to fill out and mail paperwork or submit a form online.

While the exceptions process may vary from one company to another, they all have the following in common:

  • Your healthcare provider must confirm you need the drug they prescribed.
  • Your doctor must state that your plan’s covered drugs won’t treat you as effectively as the prescribed medication.
  • Your physician believes that your plan’s covered drugs may harm you.
  • Your plan only covers the drug at a lower dosage that’s not effective for you. If you are overweight or obese, for instance, you may need a higher dose that’s not covered by your plan.

Ask your health plan about temporary coverage during the exceptions process. Your insurer may agree to cover the drug until they decide.

If your plan decides to cover the medication long term, it will most likely place it on the highest tier. Be prepared to pay an amount comparable to the most expensive drugs on your plan.

If your plan says no to your request, don’t fret. You still have options. First, your plan must explain their decision. Next, you have the right to appeal the decision. In fact, your insurer is required to tell you about the appeals process. The appeal can take place internally or externally.

Internal appeal: You may ask your insurer to perform a complete and fair review of the decision. For patients in life-or-death situations, your plan must conduct its review immediately.

External appeal: You can take your request to an independent third party. That means your insurance company will not have the final say over your request.

 

Still need help?

Our enrollment team is ready to help you navigate the confusing world of health insurance. You can chat with us on our website or email us at support@takecommandhealth.com.  

In the meantime, check out our guide on how to save for prescriptions! It’s loaded with tips and tricks to help you get the best deal. 

 





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