Check your insurance plan’s formulary. This list details covered medications and their associated costs. Many online pharmacies offer tools to check coverage directly on their websites, often requiring your plan’s information (e. g., your Pharmacy Benefit Manager’s name and your member ID). This process helps you determine which medications are covered and their copay amount Before ordering.
Understanding Your Copay and Out-of-Pocket Costs
Your copay varies based on your plan’s tier system. Generic drugs usually fall into lower tiers, resulting in lower copays, while brand-name medications might be in higher tiers, leading to higher costs. Carefully review your Explanation of Benefits (EOB) statements after each purchase to verify your costs and ensure accurate billing. If discrepancies arise, contact your insurance provider immediately.
Mail-order pharmacies frequently offer lower costs per prescription for maintenance medications. Explore this option if your insurance plan allows it. Some plans even require the use of mail-order for certain medications to receive the best price. Compare prices across both online and traditional pharmacies, factoring in shipping costs for online providers.
Prior Authorizations and Specialty Medications
Specialty medications often require prior authorization from your insurance company. This means your doctor needs to submit a request justifying the medication’s necessity before your insurer approves the prescription. Online pharmacies can often assist with this process. Be proactive; contact your doctor and the pharmacy to initiate this process well in advance of needing your medication.
