Prescription Insurance: What It Covers and How to Save on Medications

When you hear prescription insurance, a type of health coverage that helps pay for medications prescribed by a doctor. Also known as pharmacy benefits, it’s not just about getting your pills—it’s about keeping your out-of-pocket costs from eating into your budget. Most people assume their plan covers everything, but that’s not true. Many plans have lists called formularies that only include certain brands or generics. If your drug isn’t on the list, you could pay double—or more.

That’s where generic drugs, medications with the same active ingredients as brand-name drugs but at a fraction of the cost. Also known as generic medications, they’re proven safe and effective, and they make up 90% of all prescriptions in the U.S. But here’s the catch: even with prescription insurance, you might still pay more for a generic if your plan puts it in a higher cost tier. Some plans charge more for generics that aren’t on their preferred list. And if your doctor prescribes a brand-name drug when a generic exists, your insurer might require you to try the cheaper version first. This is called step therapy, and it’s common.

Then there’s the issue of medication costs, the total price you pay after insurance kicks in, including copays, coinsurance, and deductibles. A $100 pill might seem cheap after insurance, but if you’re taking three a day, that’s $9,000 a year. And if your plan has a deductible, you pay full price until you hit that number. Some people don’t realize their deductible applies to prescriptions too. That’s why checking your plan’s summary of benefits isn’t optional—it’s essential.

Don’t assume your pharmacy will tell you the cheapest option. Pharmacists often can’t speak up unless you ask. If you’re paying too much, ask if there’s a lower-tier generic, if your insurer offers a mail-order option, or if a 90-day supply costs less than three 30-day ones. Many plans save you money with bulk refills. And if you’re on a fixed income, look into patient assistance programs—many drugmakers offer free or discounted meds to those who qualify.

Prescription insurance isn’t a magic shield against high drug prices. It’s a tool, and like any tool, it only works if you know how to use it. The posts below break down real situations: how generic substitution affects your wallet, what to do when your insurance denies coverage, how to read your explanation of benefits, and why some drugs cost more even when they’re the same chemical. You’ll find guides on saving on blood pressure meds, diabetes pills, antidepressants, and more—all without switching doctors or skipping doses.