Q1. What is a "tiered" pharmacy program?

A1. A tiered pharmacy program offers incentives for members to choose drugs that are available at a discount. For example, in a plan that has three "tiers," the lowest cost drugs might be those that are generic and listed on the formulary; the mid-cost drugs, those that are name-brand and listed on the formulary; the high-cost drugs, those that are not included on the formulary at all.

Q2. What is a drug formulary?

A2. Each health plan develops its own preferred list of FDA-approved generic and brand-name drugs, called a drug formulary. These drugs generally have the lowest out-of-pocket cost to members. The formulary is chosen by a committee of doctors, pharmacists and other medical experts who consider many cost and quality issues as they make their decisions.

Q3. I'm not confident generic drugs are safe. How do I know they will work the same as a brand-name drug?

A3. According to the FDA, generic drugs (also called generic equivalent or generic substitute) must be biologically equal to a brand-name drug. Generic drugs must contain the same active ingredients as the brand name and must deliver the same amount of medicine into the system in the same way. In most cases, generic drugs can be substituted for brand names without physician approval.

Q4. Does my doctor know what is and isn't on my drug formulary?

A4. Every health plan has its own unique formulary, so it can be difficult for doctors to know exactly what is and isn't included without checking. If you receive a prescription, ask your doctor or nurse to check the online formulary before you leave the office. This way, you won't run into any delays or confusion when you get to the pharmacy.

Q5. I heard that nationally the cost of prescription drugs could be greatly reduced if patients would take more control over what they are taking. How can I contribute to lowering pharmacy costs?

A5. Nationally, the cost of prescription drugs could be reduced by $8 to $10 billion a year with generic alternatives, according to the Congressional Budget Office. Asking for generics whenever possible (your doctor may insist on a certain brand name at times) may be the most important step you can take to lower costs for yourself and our company. Another important step is to talk to your doctor about over-the-counter options. From cold medicines to antacids to eye washes to wart removers, there are countless over-the-counter solutions available that once were available only by prescription. By consulting with the pharmacist, you'll not only save on the cost of a prescription, but you'll also save the cost of an office visit.

Q6. What if my doctor prescribes something that is not included on the formulary?

A6. You should become familiar with your health plan formulary and share a copy with your doctor. Doctors are intent on helping their patients get the drugs they need at prices they can best afford. You should also make a "brown bag" appointment with your doctor. If you are on multiple medications (including over-the-counter drugs, herbal supplements and vitamins), put everything in a bag and take it with you to a doctor visit at least once a year. You may be taking medications you no longer need, or some might not work well together. Safety is the primary concern, but you may end up saving money, too. In between visits, talk to your doctor and pharmacist regularly about possible drug interactions.

Sources: Kaiser Family Foundation, Prescription Drug Trends: A Chartbook Update, March 2003; Industry Facts-at-a-Glance, National Association of Chain Drug Stores, at www.nacds.org (2001 retail price); Pharmaceutical Research and Manufacturers of America at www.phrma.org/publications; www.instituteedc.org.