Not every health plan covers the cost of prescriptions. If you are very healthy and don’t take prescription drugs often, then this will be less important to you. But if you do take a prescription on a regular basis, make sure you can get coverage, and make sure the prescription co-pays seem fair.
Co-pays for prescriptions are addressed in tiers. Tier One drugs are least expensive, and the co-pay will be the least amount. Tier Two drugs cost more and Tier Three drugs cost still more. The co-pays will be expressed as if they are ratios, something like $15/$20/$25 or $25/$40/$50 – for Tiers One, Two and Three respectively.
Recently, a fourth tier has been added to many insurers' lists of drugs called "formularies." The fourth tier will apply to very expensive drugs and the ratio costs won't be expressed. Ask your potential insurer whether they use a fourth tier and if so, how it is calculated.
In our family scenario above, those six prescriptions may cost as little as $90 over the course of the year, or as much as $300 even with coverage, and that’s if they are only needed for one fill. A drug that is taken daily for a year will be worth 12 of those co-pays because it may have to be refilled 11 times more. It’s worth it to take the time to do the math.
