Control Your Drug Costs
Controlling drug costs is one of the major challenges of our health care system. CareFirst helps to manage these expenses through the formulary system, which gives preference to the most effective medications that are also the most cost-efficient.
Depending on your plan, prescription drugs fall into one of the following drug tiers and the price you pay is determined by that tier.
Tier 0: $0 Cost Share Drugs are available at no cost for preventive drugs if you meet the eligibility requirements outlined by the Affordable Care Act. Oral chemotherapy drugs and diabetic supplies (needles, lancets, test strips and alcohol swabs) covered under the pharmacy benefit are also available at no cost for non-Health Savings Account (HSA) plans. If you have an HSA, you must first meet your deductible. For the most up-to-date list of preventive drugs, oral chemotherapy drugs and diabetic supplies go to the Drug Search page.
Tier 1: Generic drugs typically contain the same active ingredients and are the same strength as brand-name drugs. These medications are significantly less expensive than their brand-name counterparts, and are offered at a lower out-of-pocket cost.
Tier 2: Preferred brand drugs are drugs that are not yet available in generic form. These drugs are chosen for their effectiveness and affordability compared to non-preferred brand alternatives. When no generic medications are available, selecting “preferred” brand medications is a way to save money.
Tier 3: Non-preferred brand drugs are drugs that are more expensive than their preferred brand or generic counterparts and often have less expensive therapeutic options in a lower tier.
- Generics, when available, are routinely dispensed unless your physician determines that a brand-name medication is necessary for your overall health.
Tier 4: Self-administered injectables/specialty drugs often have the highest out-of-pocket cost. They are used to treat chronic, complex or rare diseases often requiring an injection or infusion. These drugs are very expensive and may require special handling. Members using them often need expert clinical support.
Generic drugs account for 80 percent of prescriptions in the U.S. and can cost up to 80 percent less than their brand-name counterparts. Generic drugs are a great alternative that may save you money. Made with the same active ingredients as their brand-name counterparts, generics are also equivalent in dosage, safety, strength, quality, performance and intended use. Use our Preferred Drug List found in the Drug Search section to see if a generic is available to treat your condition. Talk to your doctor or pharmacist about switching to a generic drug.
Here's a sample of brand-name versus generic drug costs. If your medication doesn't have a generic equivalent, ask your doctor if there's a generic alternative that will work for you.
Average Monthly Cost* of Brand
Average Monthly Cost* of Generic
Monthly Savings if using Generic
|AMBIEN (10mg)||ZOLPIDEM TARTRATE||$329||$2||$327|
|COUMADIN (2mg)||WARFARIN SODIUM||$50||$3||$47|
|LIPITOR (20mg)||ATORVASTATIN CALCIUM||$239||$5||$234|
|SINGULAIR (10mg)||MONTELUKAST SODIUM||$177||$7||$170|
*Costs based on August 2014 prices at CVS pharmacies and rounded to the nearest dollar.
To help you get the most savings, we will notify you by mail about opportunities to save with generic drugs. If you fill a prescription for a non-preferred brand drug you will be notified of lower-cost generic alternative options.
Our Mail Service Pharmacy gives you a convenient way to fill your prescriptions with fast, accurate home delivery. Plus, it's an easy way to save on your maintenance medications. Maintenance medications are drugs you take regularly for ongoing conditions such as diabetes, high blood pressure, or asthma. If your plan requires a copay, you can get a 3-month supply for just 2 copays. If your plan requires coinsurance, your maintenance drugs may cost less through mail service because our negotiated price is lower than with retail.
To see a list of maintenance medications, go to the Drug Search page, choose the appropriate drug list, and click on "Maintenance Medications" from the search options. Members can sign up for mail service today by calling CareFirst Pharmacy Services at (800) 241-3371, logging in to My Account, or completing the Mail Service Order Form.
When similar medications are available in multiple forms, Step Therapy guides your doctor to prescribe the lower-cost version first. You may then move up the cost levels until you find the drug that works best for you.
Higher-step drugs will require advance approval (prior authorization) by your doctor before they can be filled. For more information, call CareFirst Pharmacy Services at 800-241-3371.
Preventive drugs identified through the Affordable Care Act are also available at no cost to you. View the most-up-to-date version of the Preventive Drug List for eligibility requirements.