How to Lower Your Prescription Drug Costs

Chances are you or someone in your family takes one or more prescription medications. If so, you’re probably paying more for them, as the cost of many drugs has been going up rapidly. In 2022, the prices of nearly 2,000 prescription drugs increased more than the rate of inflation, according to the U.S. Department of Health and Human Services.

Would you like to lower your prescription drug costs? You may be able to using our online tools. Searching our lists of covered medications, you can find out if a less-expensive alternative is available for a drug you are taking. We’ll show you how to do it and discuss how to get your prescription switched to a lower-cost medication.

Prescription Coverage Explained

First, let’s take a quick look at how our prescription drug coverage works and explain a few important things you’ll need to know. We asked Laurie Brady, one of the pharmacists on our staff, to help break it down for us.
Our prescription drug coverage is called Vermont Blue Rx^SM. Not all of our health plans include prescription drug coverage, so look at your member ID card to see if it says Vermont Blue Rx on it. If it does, your plan includes pharmacy benefits. On the back of the card, you’ll find the phone number to call for questions about Vermont Blue Rx — (866) 227-7849.

If you have Vermont Blue Rx, on the front of the card you’ll see the word formulary. That’s an industry term for the list of covered prescription medications, Brady says. “They are chosen for coverage based on their safety, cost, and effectiveness,” she says.

Next to formulary, you’ll probably see either NPF or BCBSVT. That indicates which of our two main formularies applies to you. The National Performance Formulary (NPF) covers the vast majority of our members, including people who buy their health plans through Vermont Health Connect, Brady says. 

Both formularies are organized into three tiers, which represent different drug cost levels, Brady says.

• Tier 1 is the least-expensive medications. They are primarily generic drugs, although there may be some brand name drugs included in the tier.
• Tier 2 consists of drugs priced in the middle of the range. They are typically preferred brand name medications.
• Tier 3 is made up of the most-costly medications, often higher-cost brand name drugs. Many Tier 3 drugs have lower-cost options in Tiers 1 or 2.

Members’ cost sharing for a prescription drug depends on which tier it is in, Brady says. Medications in a lower tier often have less out-of-pocket costs than drugs in higher tiers. If you have a high-deductible plan, the tier cost levels will apply once you meet your deductible. 

For example, a member with our Standard Gold plan would have a $15 co-payment for a prescription drug in Tier 1 (the $200 pharmacy deductible is waived for generics). Medications in Tier 2 have a $60 co-payment after the $200 deductible is satisfied, while drugs in Tier 3 have 50 percent co-insurance, after the $200 deductible. So, Tier 1 drugs represent substantial savings for members, compared to drugs in Tier 2 and Tier 3.

To find out your cost sharing for prescription drugs, check your summary of benefits and coverage, which is available in the Member Resource Center.

Using The Formulary

Here’s how to use our formularies to see if you can save money on your prescription drugs.

1. Go to the Lists of Covered Medications page on our website.
2. Click on the formulary that’s listed on the front of your member ID card (either NPF or BCBSVT). For accurate information, it’s important to use the correct formulary.
3. Type the name of a prescription drug you are taking into the search box, then hit enter.
4. Look for the dosage you are taking in the results list.
5. Once you’ve found your correct dosage in the list, note which tier it is on.
6. Look at the rest of the results list to see if there are similar drugs that are on lower tiers. 

For example, searching the NPF for Cipro (an antibiotic used to treat infections) shows that it is a Tier 3 non-preferred brand drug. However, the search results also show that several versions of the generic ciprofloxacin are on Tier 1 of the formulary. Switching from the brand name drug Cipro to the generic ciprofloxacin would save members money at the pharmacy. 

If a drug is not covered, the formulary will usually provide the name of a preferred alternative that is covered, Brady says. “That would give the member an idea of what would likely cost them less out of pocket.” 

If you find that a drug you are taking has an alternative on a lower tier, Brady says you can talk with your provider about switching. “I would call my physician and say ‘do you feel any of these would be appropriate for me?’” she says. “Many Tier 3 drugs have lower cost options in Tier 1 or Tier 2. It would be appropriate to talk with your physician about whether one of those alternatives would work for you.” 

If the provider agrees to switch your medication, they would have to submit a new prescription for the alternative to the pharmacy, Brady says.

What about new drugs that your provider wants to prescribe? Before a new prescription is sent to the pharmacy, you may want to check the applicable formulary to see which tier it’s on. You can also call Vermont Blue Rx to find out in advance how much it will cost you. If it’s going to be too much, have a discussion with your provider about less-expensive alternatives, such as those suggested in the formulary.

Maximizing Your Benefits

We hope this article has helped you better understand your Vermont Blue Rx pharmacy benefits, and that you’ll use this information to maximize your benefits. You can also find a network pharmacy or learn more about our home delivery pharmacy option. 

If you’d like to better understand the medications you are currently taking and discuss alternatives that might work better, check out our free Lifestyle and Medication Guidance Program. Our pharmacist will give you a one-on-one consultation and talk with you about other options that are available, if you are experiencing side effects or want a lower-cost choice. If you like, our pharmacist can talk with your health care providers to make recommendations for alternative medications.