What is a prescription insurance provider

If you’ve ever needed prescription drugs, you know they can play an important role in keeping you healthy. Maybe you take regular medications — or maybe you’ve only needed medication for specific treatments. No matter what, it’s helpful to know how your benefits work. It can help you get your prescriptions filled more easily and help you control costs too. Let’s walk through some tips on how to use your pharmacy benefits for prescription drugs.

You’ll find the detail about most prescription drug benefits by looking at your plan’s Prescription Drug List (PDL), also called a Formulary. It’s a list of medications and how they’re covered by your plan. If you have a prescription for a certain kind of medication, you can look it up in your PDL to see how it’s covered.

You can sign in to your health plan account and look under your pharmacy and prescription coverage information to see your plan’s PDL. You may also view a general PDL, but you’ll need to confirm your specific coverage details before filling a prescription.

When your doctor prescribes medication, look at your list and talk about the cost. You can ask about a lower cost alternative if the drug your doctor chooses is too expensive or isn’t covered. At times, a similar drug can work just as well — like if there’s a generic version of the drug.

PDLs may change. If you have medications you take regularly, watch your PDL and track changes to stay ahead of possible changes in cost.

With some plans, you have the choice to fill your prescriptions at a participating network pharmacy or with home delivery by mail.

Choosing a network pharmacy may help you save on costs. You can view list of pharmacies for your plan by signing in to your health plan account. If you don’t use a participating network pharmacy, you may have to pay the full retail price for your prescriptions.

You can also view a general list of pharmacies using the OptumRx Pharmacy Network Search.

If your prescription medication benefit includes home delivery, you can avoid monthly trips to the pharmacy and you may save money too. You may be able to order up to a 3-month supply of medication you regularly take — and there’s usually no charge for standard shipping within the U.S. You can enroll in just a few steps when you sign in to your health plan account or call the number on your member ID card.

On your prescription benefits, you may see the name OptumRx®, which is UnitedHealthcare’s pharmacy service provider. OptumRx may be included in your health plan benefits because it offers members coverage through a large network of retail chain and independent pharmacies, as well as through its mail service pharmacy known as OptumRx Home Delivery and the Optum Specialty Pharmacy.

UnitedHealthcare members with health plans through an employer may use the UnitedHealthcare app to help manage their medications. You can use the app to:

• Set up and refill home delivery orders
• Track your prescription history
• Find network pharmacies
• Compare medication prices

Here are a few ideas that may help you save on your medications.

•  Check your Prescription Drug List (PDL) often to stay ahead of changes in coverage
• Talk to your doctor about lower-cost alternatives if a medication is too expensive
• Sign in to your health plan account to find network pharmacies

A requirement that your doctor explains why you need a certain medication before your plan decides how and if it will be covered.

Supply/quantity limits

The largest amount of medication your plan will cover per copayment or period of time. Some medications have quantity limits for quality and safety reasons.

Step therapy

When your plan requires you to try one or more medications before approving coverage for a different one.

Specialty medications

Medications used to treat complex or rare conditions that you may need to get from a specialty pharmacy.

A trip to the pharmacy can cost you a lot, especially if you’re taking multiple medications. Participating in a prescription drug plan is one way to help cut your pharmacy costs.

What is a Prescription Drug Plan?

Prescription drug plans are commercial health insurance plans that help lower prescription costs in exchange for a monthly payment. As supplemental insurance plans that cover prescriptions only, these plans usually supplement Medicare coverage or other clinical care-only health insurance plans. A prescription drug plan can help you save money and make getting your prescription medications easier.

How Do Prescription Drug Plans Help You Save Money?

The simplest way these plans save money is by covering the majority of your medication costs. Some plans may require you pay a small copay – a flat fee for your medications.

The medications covered by your plan are listed in your plan's drug formulary. It’s a list of medications your prescription drug benefits cover. Most common medications are included in drug plan formularies, but if a specific medication isn’t covered, your doctor may be able to substitute a generic drug – another brand of drug designed to treat the same condition.

In addition to pharmacy savings that come from a prescription drug plan, you may be eligible for additional savings at your plan's preferred pharmacy. A preferred pharmacy has an agreement with your prescription drug plan provider to offer medications at a lower out-of-pocket cost to you. Some plans may offer a preferred drug list that offers even more savings on generic drugs and certain brands of medications.

Prescription drug plans often provide convenience benefits like mail delivery. Services like these help you get your medications if you’re sick, injured or without transportation.

Types of prescription drug plans

For individuals

If you have an individual health plan that doesn’t provide you enough prescription drug coverage, you can purchase an individual prescription drug plan for added support. For a monthly payment, it’ll save you money on medications in the long run. This plan offers pharmacy cost benefits not covered by your health insurance, and sometimes additional benefits like mail order medication delivery.

For Medicare enrollees

Original Medicare (Medicare Parts A and B) pays for your doctor and hospital visits, but not prescription medications. To cover your prescription costs, you can add an optional Medicare Part D plan to your Medicare coverage. To enroll in Part D, you must be enrolled in Medicare Part B or Medicare Part C (Medicare Advantage). Insurance providers may offer multiple Medicare Part D plans (with different monthly payments, copays and preferred pharmacies) and let you choose the option that works best for you.

More Ways to Save on Prescriptions

Take advantage of your pharmacy’s rewards program or use a health savings account (HSA) or flexible spending account (FSA) to pay for out-of-pocket costs. For medications not listed on your formulary or for prescription drug plans with out-of-pocket coinsurance, discount plans like RxSaver and HoyMeds may help you save money. For expensive, brand name drugs that have no generic version, you may qualify for a rebate through the drug manufacturer.

Combining these options with a prescription drug plan can help you maximize medication and pharmacy savings. Learn more about prescription drug plans with CareFirst.