First off, happy Independence Day! Let’s talk about a contributor to financial independence. If you’ve struggled with prescription costs, you might be dealing with a pharmacy benefit manager (P.B.M.). P.B.M.s decide which drugs are covered and how much you pay, acting as middlemen between your insurer and pharmacies. They aim to save money on medications, but sometimes they make you overpay for prescriptions.

Most Americans use one of three major P.B.M.s: CVS Caremark, Express Scripts, or Optum Rx. These companies manage drug benefits for many insurance plans, including Medicare. Unlike health insurance plans, you can’t choose your P.B.M. It’s assigned by your employer or insurance provider, often identified on your insurance card.

P.B.M.s influence your out-of-pocket costs by creating a list of covered drugs, known as a formulary. They make some drugs cheaper by offering them at a lower copay, while making others more expensive. If your medication costs seem high, it might be due to your P.B.M.’s pricing strategies. They might require you to take a brand-name drug over a cheaper generic alternative, or you might pay more through insurance than you would paying out of pocket.

To avoid overpaying, talk to your pharmacist. They can suggest cheaper alternatives and might advise paying out of pocket instead of using insurance. Tools like GoodRx and the Mark Cuban Cost Plus Drugs Company can help you find lower prices. If you face high drug costs, your pharmacist might offer options like paying over time or using manufacturer’s coupons.

While you can’t change your P.B.M. directly if you have employer-based insurance, you can voice concerns to your employer’s human resources department. For Medicare recipients, you can choose a new plan during the annual enrollment period, potentially switching to a plan with a different P.B.M. Always compare plans on Medicare’s website to ensure you’re getting the best coverage and prices for your medications.

By understanding your P.B.M. and exploring all options, you can take control of your prescription costs and ensure you’re not overpaying for prescriptions to your essential medications. We here at Arizona Elder Care are here to help, so please reach out to us! We work with you to save on medication costs and more.