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 and Advil. 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 A formulary 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- dine 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. A typical formulary might include the followinggroups (also called levels or tiers): What are preferred and non-preferred drugs?
Often two brand-name drugs are useful for Co-pay size
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. ing 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 ( 2/02


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