How to save on prescription medications and maximize your benefits

(BPT) - At a time when prices everywhere seem to be on the rise, it's natural to have concerns about the cost of your prescription medications. For many, these costs are affecting how consistently they take their medications, which can impact their health now and in the long run. According to KFF, 43% of U.S. adults say they haven't taken their medication as prescribed in the past year because of the cost, and 6 in 10 also say they're worried about being able to afford their prescription medications.

It's natural to have questions about your medications, such as whether there are lower-cost options, or if your healthcare plan offers any potential savings. And finding answers can be critical when the costs affect whether people take their medications as prescribed.

"If you don't know where to begin looking for answers to your questions about prescription medications, you're not alone," said Joshua Fredell, PharmD and senior vice president at CVS Caremark. "CVS Health is here to help you understand your benefits, costs and options to help you keep taking the medications you need to stay healthier."

Fredell explains some of the terminology around prescription benefits and shares available plan resources and savings opportunities to help you stay on track with your treatment.

What a Pharmacy Benefit Manager does

Pharmacy Benefit Managers (or PBMs) negotiate discounts for their customers that help lower the cost of prescription drug coverage. For example, CVS Caremark^® is a PBM under CVS Health. PBMs build pharmacy networks that support broad access to high-quality care within local communities while helping control costs.

Your PBM can explain the details of your prescription drug plan, and can also help you explore cost-saving options by offering you more choices, such as generic or biosimilar drugs.

Why sticking with your treatment plan is so important

It's crucial to prioritize taking your prescription medications as directed, in order to achieve their intended benefits — which in the long run can reduce your overall healthcare costs and keep you on track to feeling better.

Whenever you have concerns about your prescription medications, it's important to talk to your pharmacist, doctor and other healthcare professionals on your care team to help you make more informed decisions about your health.

Understanding terms about your coverage

Here are some definitions for common terms you have probably seen as part of your healthcare or prescription plan, and why they're important for understanding your coverage and benefits.

• Formulary refers to your plan's list of covered medications. The formulary is designed to help you get the medication you need at the lowest possible cost. When your doctor prescribes a formulary medication, you will pay your plan's required copay or coinsurance at the pharmacy.
• Prior authorization (PA) is a review process that a member's plan uses to make sure the medications, tests and treatments they receive are clinically appropriate, safe and affordable.
• A deductible is the set amount of money in your plan that you pay (also referred to as out-of-pocket) for covered medications and healthcare before your insurance plan begins to pay.
• A high-deductible health plan (HDHP) generally requires you to pay the full cost of your healthcare, including prescriptions, until you reach your plan's annual deductible amount.
• An out-of-pocket maximum is the highest amount you'll pay for covered health services and prescriptions in one calendar year. Your prescription copays, coinsurance and deductibles paid for covered medications (usually filled thru CVS Caremark or your specific health plan) count toward this maximum limit.

Using the resources in your plan

You can register for a CVS Caremark account to help you get more from your prescription plan. As a member, you'll receive information about cost-saving options that may be available to you, plus access to pharmacists and other experts who can help you understand your choices and provide access to available resources.

"Even when you have concerns about expenses, skipping doses or not filling your prescriptions can negatively impact your health, and cost you more in the long term," said Fredell. "So if you're struggling with cost, reach out to your Pharmacy Benefit Manager to ask about savings options that can help."

Learn more about ways to better manage your prescriptions and get all your questions answered at CVSHealth.com.

Coverage and cost-sharing vary depending on individual plan design and state requirements. Savings opportunities described may not be available under all health plans.