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Prescription Coverage

Every health insurance plan is different; it is important to know if your plan has prescription drug coverage and how it works. Some programs do not offer any prescription drug coverage.

What's included with Prescription Drug Coverage?

Many health insurance plans do not offer complete prescription coverage for all drugs. It is common for some drugs to be excluded completely. There is a list of what the health insurance provider will cover for particular drugs or types of drugs. You may have to specifically request this list. You could be required to use a particular pharmacy for your prescriptions to be covered by your health insurance provider.

Does Prescription Coverage cover the brand name or only generic?

It depends on your health insurance plan. You will usually have to pay a higher co-payment if you want brand name drugs.

How much do I have to pay When Using Prescription Coverage?

Nearly all plans will charge a co-payment for prescription medication, either a flat fee per prescription or a percentage of the cost. Make sure you understand your policy and check the pharmacy bill to see that you are billed appropriately.

What are formulary drugs?

A formulary is the list of drugs that your health insurance covers. Some health plans also cover a portion of the cost of drugs not on the formulary, but others do not cover them at all. Be aware that some drugs require prior approval before they will be covered by the health insurance company.

Are there exceptions to Prescription Coverage?

If your doctor recommends a drug that is not on the formulary and/or if you meet other qualifications (such as if you have an allergy to the formulary drug) you can often make a special request for your health insurance provider to cover the drug. Your policy will describe the process; contact your health insurance agent for details.

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