Prescription Drug Coverage: What You Need to Know to Save Money and Stay Covered

When you hear prescription drug coverage, the part of your health insurance that pays for medications you need. Also known as pharmacy benefits, it’s not just about whether your drug is covered—it’s about how much you pay, which version you get, and how often your plan changes without telling you. Most people assume if a drug is FDA-approved, their insurance will cover it. That’s not true. Coverage depends on your plan’s formulary, the list of drugs your insurer agrees to pay for, and where that drug sits on its tier system, a ranking that determines your out-of-pocket cost. Tier 1 might cost $5. Tier 4 could cost $200. And if your drug gets moved to a higher tier? You pay more—no warning, no choice.

That’s why generic drugs, medications that work exactly like brand-name versions but cost far less are your best friend. They’re not cheaper because they’re weaker—they’re cheaper because the patent expired. The FDA requires generics to match brand-name drugs in strength, safety, and how they work in your body. But your insurance plan might still push you toward a brand if it gets kickbacks from manufacturers. That’s why checking your formulary isn’t optional—it’s a money-saving habit. If you’re on Medicare Part D, the rules get even trickier. Some plans have coverage gaps (the donut hole), and others require prior authorization just to fill a simple prescription. And if you switch plans during open enrollment? You could wake up one day with your favorite drug suddenly $300 a month instead of $15.

It’s not just about the price tag. It’s about access. If your plan doesn’t cover a generic version of your medication, you might end up paying more than if you bought it out of pocket. Some people don’t even know their meds are covered under a different name—like how metformin is the generic for Glucophage. And if you’re on multiple prescriptions? A change in one drug’s tier can ripple through your whole budget. That’s why people who track their coverage like a budget spreadsheet end up saving hundreds, sometimes thousands, every year. You don’t need a degree in pharmacy to do this. You just need to know where to look: your plan’s formulary, the tier list, and the fine print on your Explanation of Benefits.

Below, you’ll find real, practical guides that show you exactly how to check your coverage, avoid surprise costs, switch plans without getting stuck with an expensive drug, and make sure you’re not overpaying for something that’s just as effective—and way cheaper—as a brand-name version. Whether you’re on Medicare, a private plan, or just trying to understand why your pill cost doubled last month, these posts give you the tools to take control.