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Health Care Reform:

Health Insurance & Affordable Care Act

Prescription Drug Costs and Health Reform: FAQ

What will I pay for medicines?

With some health plans, you pay a coinsurance for your medicines. This is a set percentage of the drug's cost, such as 30%. With some health plans, you pay a prescription copay, which means you pay a fixed amount for each medicine you buy.

Many formularies have two or more cost levels, called tiers. The copayment for each tier will likely be different. Higher level tiers cost you more. For instance, a third tier medicine costs more than a first tier one.

Many health plans have three or four tiers of costs:

  • Tier 1: Generic medicines, which cost the least
  • Tier 2: Preferred, brand-name medicines
  • Tier 3: Non-preferred, brand-name medicines
  • Tier 4: Specialty medicines, which are often costly, brand-name medicines. For instance, chemotherapy may be a fourth tier medicine.

Keep in mind that you may have a separate deductible for prescription drugs. You may need to pay it as well as a deductible for medical services. Look at a plan's summary of benefits about prescription medicines to see what you'd be responsible for paying.

After picking a health plan, how can I save money on my medicines?

You may be able to save more money even for medicines on your plan's formulary. Here's how:

Compare your medicine's price at local pharmacies. Some pharmacies also have a club where you can get a discount.

Check prices on online and mail-order pharmacies. First, make sure it’s a legitimate site. The FDA warns against the potential dangers of buying medicine on the Internet. Some signs of a trustworthy web site include:

  • It's located in the U.S.
  • It's licensed by the state board of pharmacy where the web site is operating. (Look for the National Association of Boards of Pharmacy's (NABP) Verified Internet Pharmacy Practice Sites Seal, which is also called the VIPPS seal.)
  • The site has a licensed pharmacist available to answer your questions.
  • You need a prescription from your doctor to buy a medicine.
  • There is a phone number listed for a person you can talk to about a problem or to ask questions.

Set up a flexible-spending account (FSA). Some employers offer these. You determine an amount to come out of your paychecks over the year. That amount is taken out before taxes so you can use it to pay for health expenses, including medicines.

Check out a prescription assistance program. Many health plans and some states have a prescription assistance program. Look on Medicare.gov for your state's program. NeedyMeds.org and RxAssist.org are two additional resources for finding drug assistance programs. Most pharmaceutical companies and charities also offer similar programs.

WebMD Medical Reference

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