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.
Drugs are ranked into categories (tiers) depending on your plan, and the price you pay will depend on which category a drug falls into.
- Generic drugs work the same as brand-name drugs, but cost much less. So you’ll pay less to use them. Some plans also divide generics into Preferred Generics and Non-Preferred Generics based on cost.
- Preferred Brand drugs are brand-name medications that are not yet available in generic form, but are chosen for their effectiveness and affordability compared to alternatives. They cost more than generics, but less than non-preferred brand drugs.
- Non-preferred Brand drugs are often available in less-expensive forms, either as generics or preferred brand drugs. You will pay the most for this category of drugs.
- Specialty/Self-Administered Injectable drugs (excluding insulin) are the highest priced drugs and usually have a coinsurance. These drugs may be oral or injectable drugs used to treat a serious or chronic condition.
Generic drugs account for 80% of US prescriptions and can cost up to 80% less than their brand-name counterparts. Fully approved by the FDA, generics contain the same active ingredients as brand-name drugs that have been in the system for years— but are not saddled with the high marketing expenses that inflate the price of brand-name drugs.
Here is a sample of brand-name vs. generic drug costs. If your medication doesn’t have a generic equivalent, ask your doctor if there’s a generic drug that will work for you.
Average Monthly Cost* of Brand
Average Monthly Cost* of Generic
Monthly Savings if using Generic
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 prior authorization. For more information, call 800-241-3371.
The Affordable Care Act (ACA) classifies certain therapies as “preventive” if they reduce the risk of some serious health problems. If you meet the eligibility requirements, preventive drugs will be fully covered by your prescription drug plan—available at no cost to you. You will not have to pay deductibles or copays.
The Preventive Drugs List includes a brief description of the eligibility requirements.
Drugs you take regularly for ongoing conditions such as diabetes, high blood pressure, or asthma are called maintenance medications. You may save money on your maintenance medications by ordering them at a discount through our mail-order pharmacy.
Learn More about ordering drugs online, or call CareFirst’s Pharmacy Services at 800-241-3371.