The doctor sends you off with your prescriptions in hand. You don't want to get to the pharmacist only to discover that your plan won’t cover your medications! Here’s how to avoid this tricky situation.
Know your prescription coverage. Just because your plan includes prescription coverage doesn’t mean that all your prescriptions will be covered. Check your summary of benefits:
- Does your plan have a deductible for prescriptions?
- If so, does it apply to all prescriptions? Or only select types like brands or nonpreferred (also called nonformulary) medications?
- What is your coverage for generic medications?
- What is your coverage for brand medications?
- What is your coverage for nonpreferred medications?
Next figure out…
- Is your prescription generic or brand?
- Is your prescription preferred or nonpreferred?
This last question may require a little extra research to find out. Luckily, most insurance companies make this information easily available online. You can either look up drugs on their site or download a list; you may also be able to ask your pharmacist to check for you.
Talk to your doctor. Now that you know how prescriptions are covered on your plan, find out what all your options are. If your plan only covers generics, ask your doctor if your brand medication has a generic option. If it doesn’t, see if your plan would agree to cover it if you get prior authorization.
The key is open, direct, proactive communication with your doctor, before visiting the pharmacy.
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