Start With Your Medication List
Write down each prescription, dosage, frequency, and whether you use a brand or generic version. That lets you compare plans using the medications you actually take instead of a generic drug benefit summary.
Check the Formulary and Drug Tier
A formulary is the plan’s list of covered medications. Drugs may be placed on different tiers with different copays or coinsurance. A medication can be covered but still be expensive if it sits on a higher tier.
Look at Pharmacy Networks
Preferred pharmacies may offer lower cost sharing than standard network pharmacies. Mail-order options can also differ, so include your preferred local pharmacy when comparing plans.
Review Prior Authorization and Step Therapy
Some medications require prior authorization, quantity limits, or step therapy before the plan will cover them as expected. These rules can be as important as the listed copay.
Do Not Forget the Deductible
Some plans have prescription costs that apply before a deductible, while others require you to satisfy all or part of a deductible first. Read how the drug benefit interacts with the rest of the plan.
Prescription Checklist
- Is each current medication on the formulary?
- What tier is it on?
- What would it cost at my preferred pharmacy?
- Do prior authorization or step-therapy rules apply?
- Is there a separate prescription deductible?