By Patricia Prewitt

My Personal Rx Adviser 

A client who attended a local consumer education class in 2023 reached out to me a few weeks ago to ask about a notice he received from his prescription plan. A medication he has taken for years was being dropped from coverage. He asked me if he was taking all the right steps to find the best pricing. Here are the things we talked about:

Why is my medication being dropped from coverage?

Every year, insurance plans will review their formulary list to evaluate which medications will be covered for the upcoming new year. Many factors come into play; it would be impossible for any plan to cover every medication on the market. Pharmacy teams and medical personnel evaluate the clinical information, along with pricing, and other market factors to determine which medications will be on the new list.

I am not happy, but I knew to look for a savings card. Was that the right decision?

He shared with me that using his insurance prescription insurance benefit would be about $330 a month. Yikes! He had been paying a $50 a month copay previously in 2023.

What did you find using a savings card?

He told me GoodRx had the lowest prices for his medication in his zip code; the Walmart price was $109. CVS offered a coupon price at $114 a month. He elected to stay with CVS since his prescription was already at that local pharmacy.

There are many different companies that offer savings cards; SingleCare, GoodRx and Needymeds are just a few. He knew to look at a few of them, since savings card prices will vary based on the medication, the card selected, and even the zip code.

I reminded him by using the savings card coupon and cash to pay for his medication, he was no longer using his insurance benefits. The $114 a month out-of-pocket costs will not accrue to any deductibles for his plan.

What else could he do?

The product is not yet available in a generic form, so the brand name was his only option. Costplus Drugs did not offer his medication. We talked about looking at patient assistance, but he was above the annual income level for that program.

Any other words of advice?

At his next visit, he could ask his medical provider if a medication change is warranted for a similar, covered medication on the 2024 formulary list. I reminded him about the importance of an annual Medicare Part D checkup during the annual enrollment period in October to ensure his plan covers his important medications at an affordable cost for the following year.

Content provided is for education purposes only, and is not intended as a substitute for advice from a qualified medical professional. The opinions expressed within are those of the author. 

About the Author: Patricia Prewitt is a local Massachusetts resident who spent more than 30 years in  the pharmaceutical industry. Tricia is a consumer education advocate, and loves helping people find ways to save money on their prescriptions. More information and free resources are available on her website at or call her at 508-507-8840. Favorite Quote: “Act as if what you do makes a difference. It does.” – William James