Before signing up for a health insurance plan, look at its formulary, or list of drugs covered. You want to make sure that your plan covers any medications you take on an ongoing basis.
If you start an expensive new medication and you’re stuck with a health plan that doesn’t cover it, your doctor can request a formulary exception to get the drug covered, says health insurance broker Kathleen Kasak, owner of highly rated Kasak Insurance in Elmhurst, Illinois.
“It is not a slam dunk,” she says. So ask, too, about lower-cost alternative medications, including generics and drugs listed on your formulary.
Still stuck paying out of pocket for a drug? Shop around. “GoodRx.com and similar sites can show you the cheapest cash prices for your drugs,” Kasak says.
Wherever you go, be sure to keep your primary care provider and pharmacist in the loop on everything you’re taking.
In a twist, Kasak says those with Medicare Part D and insurance purchased through the health insurance exchanges often find it cheaper to pay for drugs in cash than go through their insurance plan.
“Be aware that both types of plans track your expenses toward the [Medicare] donut hole and/or maximum out-of-pocket expense when using the drug card,” she says. “But sometimes it makes sense to pay a cheaper cash price.”