Your Guide to Prescription Savings
Managing prescription costs shouldn't be complicated. Below, you'll find PRAM's savings programs, tools like GoodRx, and assistance programs to help lower your out-of-pocket costs.
PRAM: Your Partner in Prescription Savings
PRAM offers several programs to help lower your prescription costs — from a $0 copay on common medications to dedicated support for expensive specialty drugs. Explore the options below to find the best fit for your needs.
Exclusive RX
Access over 260 common medications at a $0 copay, plus non-insured virtual services like vision and hearing screenings.
Key Benefit: $0 cost on ExclusiveRx formulary medications.
Best for: High-deductible plans or common acute care needs.
RX Boost
A dedicated Patient Advocate finds savings on high-cost specialty medications through manufacturer and copay assistance.
Key Benefit: Personalized advocacy for specialty drug savings.
Best for: Expensive brand-name specialty medications.
CostCare RX
Always pay the lower of your copay or the PRAM network rate, with a pharmacy price look-up tool.
Key Benefit: "Lesser of" pricing guarantees the lowest available cost.
Best for: Consistent savings on a wide range of medications.
Lyric Lean
A monthly program combining GLP-1 medications like Ozempic and Wegovy with personalized clinical support.
Key Benefit: Holistic, medically-supervised weight-loss support.
Best for: Anyone seeking a comprehensive GLP-1 weight-loss program.
GoodRx is a free prescription discount service — not an insurance plan — that helps you find lower cash prices at pharmacies near you. Prices can vary significantly from pharmacy to pharmacy for the same medication, and GoodRx makes those differences easy to compare. Simply search your medication, dosage, and location to see discounted prices nearby, then show the coupon (or a screenshot) to your pharmacist at checkout. It's especially useful if you're uninsured, have a high deductible, or your medication isn't covered by your plan.
Patient Assistance Programs are offered by pharmaceutical manufacturers and nonprofit organizations to provide free or significantly reduced-cost medications to people who qualify — typically based on household income, insurance status, or a specific diagnosis. These programs are especially valuable for expensive brand-name or specialty medications that aren't easily covered through discount tools like GoodRx. Every program has its own eligibility requirements and application process, so the easiest way to find one is through a free search tool like NeedyMeds, which lets you search by medication or condition to find programs you may qualify for.
How Your Health Insurance Covers Prescriptions
Health insurance plans use specific terms and structures to determine how much you pay for your medications. Knowing these terms can help you predict your costs and make the most of your pharmacy benefits. Here are some of the most important concepts to understand:
Formulary (or Drug List): This is a list of all the prescription drugs your health insurance plan covers. Most formularies are "tiered," meaning they separate drugs into different cost levels. To find out if a specific drug is covered and what tier it falls under, you can usually look it up on your insurance company's website or member portal.
Tier 1: Generics
These are the lowest-cost medications. They have the same active ingredients as brand-name drugs but are often priced much lower - making them the best option if available.
Tier 2: Preferred Brand-Name
These are brand-name drugs that your plan has a special agreement with, so they cost less than non-preferred brands - a good middle ground option when generic is not available.
Tier 3: Non-preferred Brand-name
These are more expensive brand-name drugs. Your plan may cover them, but at a higher cost to you - often because a similar, cheaper alternative exist in a lower tier.
Specialty Medications
High-cost, complex medications used to treat serious conditions like cancer or MS. Often requires prior authorization and has the highest out-of-pocket cost.
Quick Tip: Formularies can change. Always confirm your coverage and cost with your insurance or pharmacist before you go to the pharmacy.
What to Do if a Prescription is Denied?
Your insurance company may deny coverage for a medication. This can happen for several reasons, such as the drug not being on your plan's formulary, a lack of 'medical necessity' on file, or a requirement for prior authorization. If this happens, you have the right to appeal the decision.
Here are the key steps you can take to challenge a denial:
Contact Your Doctor
The most crucial step - they provide the documentation and support needed to make your case. Often, a denial just means the insurer needs more information.
Ask for a “Letter of Medical Necessity”
A letter explaining why the denied medication is the best or only suitable treatment for your condition can directly address the reason for the denial.
Submit the Appeal with Your Doctor’s Office
Your doctor’s office staff often has experience with this process and can help gather the paperwork, records, and letter needed for your insurance company.
Follow Up and Keep Records
Keep copies of all correspondence, and note your appeal deadlines - they’re time sensitive.
By following these steps, you can significantly increase your chances of having a denied prescription covered. Remember, you have the right to this process and your doctor’s support is your greatest asset.