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Typical Changes to Prescription Costs in January

Between 2014 and 2019, prescription costs have gone up and down, increasing as much as 12% and then decreasing at almost the same rate while spending has remained steady. With each new year, most of us are burdened with annual bills and the beginning of new billing cycles. Healthcare also goes through changes, and many people face increasing costs at pharmacies. This happens mainly because most medical insurance plans are based on the calendar year, so changes to prescription costs typically follow.


When your insurance plan resets, so does your deductible. Refer to your specific health care plan to see if prescriptions are included in your deductible. Some plans have a medical deductible and a separate pharmacy deductible. Most deductibles have increased substantially, so it can be a huge financial burden when starting over when you are paying the full price of your prescriptions on January 1. 

Drug Tiers

When becoming familiar with the prescription changes to your health care plan, refer to the formulary, the approved list of drugs your plan covers. If you know ahead of time what you need, this can help significantly in preparation for the year. Drugs listed in the formulary are classified into tiers. Health plans pay different amounts for medications depending on their tier. Generic drugs are usually in the lowest tier, while most name-brand drugs are typically in the highest. If the drug is moved to a different tier, it can affect the cost. Some drugs are completely dropped, which means you, the patient, will then have to pay full price. 

What to do as a patient

These changes do not just occur in January but throughout the year, so if you are on a particular medication and are not staying abreast of changes, you may be surprised when picking up your next prescription.

Your healthcare plan determines how much each drug costs if you are using insurance at the pharmacy. However, the prices of each drug change depending on which pharmacy you go to, much like any other product on the shelf. It is vital to check the pricing of your medicines with individual healthcare plans and pharmacies. 

Depending on how much you plan to spend on pharmaceutical drugs in the coming year, your deductible, and the cost between pharmacies, it is sometimes more cost-effective to use a discount card, such as CharityRx. The bottom line is that you should do your homework and know your costs. A little preparation can save hundreds, and sometimes thousands, of dollars. 

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