If a prescription was not covered, patients often faced full cost. Lower-cost generics, biosimilars, or alternatives were among the first options to discuss.
Patients were advised to raise cost concerns directly with prescribers, who may not know formulary details or out-of-pocket pricing under each plan.
Other cost-saving steps included comparing 90-day versus monthly fills, splitting higher-dose pills if approved, and asking prescribers for free medication samples.
If no affordable substitute worked, patients could request a formulary exception. Plans often required medical-necessity support and sometimes step therapy first.
Higher-tier or nonpreferred drugs could still cost more even when covered. In those cases, patients could ask insurers for a tier exception.
