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Prescriptions: why they're so complicated -- family practice management
from Your Family Doctor
Prescriptions: Why They’re So Complicated
Getting a prescription filled is usually easy.
What’s the difference between a brand-name
But because of the high cost of prescription
drug and a generic drug?
employers are trying to control drug costs.
it gives it a brand name.
Brand names are the
Some of the things they are doing make getting
names you usually see in ads on TV and in
a prescription more complicated for you and
magazines – names like Claritin
your doctor, and some of the terms they use can
For several years after the drug is developed,
laws prevent other drug companies from copy-ing it. When other companies start manufac-
What is a formulary?
turing and selling the drug, their versions are
is a list of medications that your
usually known by a different name – the generic
insurance company will help you pay for. This
name. This is often the chemical name. For
list is reviewed and changed by the insurance
instance, the generic name of Claritin is lorata-
and the generic name of Advil is ibuprofen.
The drugs in a formulary are often listed in
two or more groups, depending on how much
brand-name drugs, and they are often less
of the cost you are expected to pay. The amount
expensive. That’s why many insurance plans
you’re expected to pay is called your co-pay
typical formulary might include the followinggroups (also called levels
What are preferred and non-preferred drugs?
Often two brand-name drugs are useful for
may be able to get one less expensively than theother. That drug becomes a preferred drug, and
the other becomes non-preferred. That’s usual-ly why you pay more for non-preferred drugs.
a drug from the preferred list to the non-pre-ferred list. If this happens to you, your doctor
might be able to prescribe a preferred drug that
would cost you less money and work just aswell for you.
The more dollar signs in the table, the higherthe co-pay amount.
What about drugs that aren’t in the formulary?
• Keep track of the number of refills you
have left on your prescription.
drugs. Many don’t include drugs that the insur-
ance companies believe aren’t necessary to
scription refilled should be printed on the label.
improve health. These are sometimes calledlifestyle
drugs. Weight loss and hair growthdrugs are examples of lifestyle drugs. Yourinsurance company won’t help you pay for adrug that isn’t part of its formulary.
How can I make filling a prescription easier?
Here’s what you can do to reduce the chances
of having a problem when you try to fill yourprescription.
• Bring your medication bottles and a copy
of your insurance plan’s formulary to your
appointment with your doctor.
If you don’t have a copy, you can call the cus-
tomer service number listed on your member-ship card and ask to have one mailed to you.
You can also ask the customer service represen-tative whether a specific drug is covered andwhat the co-pay will be for that drug. If youhave access to the Internet, you should be able
While you have refills remaining, you can go
to find your plan’s formulary on its Web site.
directly to the pharmacy to get a new supply of
• Fill your prescription at a pharmacy that
medicine. If you are taking the drug over a long
participates with your insurance plan.
period, you’ll need to call your doctor’s office for
Insurers don’t always use all pharmacies.
a new prescription when you have no refills left.
They make deals with certain pharmacies. If you
The doctor may want to see how you’re doing
have your prescription filled at a non-participat-
before prescribing more of the medication.
pharmacy, you may pay a higher price. Ask
Remember, having the right information can
the customer service representative what phar-
save you time and money. Take the time to find
macies participate in your insurance plan.
Copyright 2002 American Academy of Family Physicians. Permission is granted to reproduce this material for nonprofit educational uses. Written permission is required for all other uses, including electronic uses.
This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is availablefrom the AAFP on the World Wide Web (http://www.familydoctor.org).
Il dott. Alberto Vannelli , si è laureato in medicina e chirurgia e specializzato in chirurgia generale a Milano con il massimo dei voti, dal maggio 2001 al novembre 2011 è stato dirigente medico presso la FondazioneIRCCS Istituto dei Tumori di Milano e dal dicembre 2011 è dirigente medico con mansione di aiuto con indirizzooncologico presso la Struttura Complessa di Chirurgia General
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