PSA: New Year Changes, Formularies, Deductibles
IPSA: Health insurance companies change their medication formulary every year so your medication may or may not be covered in 2025. AND your deductibles restart in January so there may be a high out of pocket cost at the new year.
It is helpful to contact your health insurance company so you can find out if the medications you are currently taking are still going to be covered in 2025.
AND it is a good idea to reflect on your deductible benefit because you may have a large out of pocket cost come January for medications or medical services until you reach your deductible.
What can you do?
- Call your health insurance company to see if you have any medications that are not on their 2025 medication formulary
- Call your health insurance company to learn more about your deductible and what you may have to pay out of pocket in the beginning of the year before you get "fuller" financial coverage
How often should you do this?
Unfortunately, medication formularies and deductibles are annual conversations you should be having because of how health insurance works.
Remember to stay involved in your health care so you have less surprises.
Your doctors do not know when medication formularies change UNTIL you call them and tell them you can not pick up a medication then there is chaos trying to find something "covered". Because most pharmacies do not call doctor offices about formulary changes because of volume, so it is on the patient.
Your doctors do not know your deductible benefits so communicate with them if you have a high out of pocket cost you were not anticipating because this may delay you picking up a medication and continuing your treatment plan. Your doctor may be able to switch medications if there are other treatment options.
If you have made it this far then you are one step closer to being better informed about your health care. It's challenging and I only know this because of years of reacting to the January confusion and interruptions that come with formulary changes and deductibles.
Things to consider
- Generic medications can be significantly cheaper and are more often on a formulary than a brand name medication
- Medication coupons like GoodRx can provide discounts to medications so you don't have to switch
- Small business pharmacies have programs to sometimes provide discounted medications to patients because they are more direct to customer than franchise pharmacies
- Walmart specifically has a $4 medication list that has many common medications for a set price without having to use insurance
Good things is at clinics like mine I am able to respond quickly to these needs because of the convenient and direct access. And if it frustrates too much I can offer the wholesale medication from my in house pharmacy at a low cost for most medications. But not every place is like Harris Family Health so check on your formularies and deductibles so you can be more proactive.
Harris Family Health is a innovative approach to primary care that provides accessible, affordable, and quality care to adults and children. Harris Family Health empowers patients to prioritize their health through convenient and evidenced based quality care.
Learn more about Harris Family Health at harrisfamilyhealth.com. Join Harris Family Health today.
