How to Get Prescription Drug Coverage

Did you know that your health insurance might cover your prescriptions too? Many people are unaware of this added benefit when they visit the pharmacy for a course of antibiotics or other prescription drugs. 

Behind the scenes of your health insurance plan is usually a list of approved medications that your insurer will cover in part or in full. This is known as a formulary. Some insurers may offer prescription coverage only as an add-on to your current plan. It’s always best practice to fully understand every inch of your insurance. 

Why spend money when you don’t need to? Health insurance premiums don’t come cheap. Take advantage of your entire plan or what your insurer has to offer and cut down your medication costs.  

Below we will cover everything you need to know about getting prescription drug coverage. Read on to learn more. 

Prescription Drug Coverage Options

There are a myriad of ways in which you can gain prescription coverage. You may already be entitled to it through your employment or union without even knowing. TRICARE, Medigap, and Veterans Affairs also offer prescription coverage policies. It’s worth taking the time to delve deeper into any existing insurances you already hold. 

Alternatively, Medicare offers two different routes to obtaining drug coverage. The Medicare Prescription Drug Plan is often referred to as Part D is a drug-specific add-on to your existing Medicare plan. 

You can also opt for a Medicare Advantage Plan (Part C), which is similar to an HMO or PPO plan. With this option, you’ll receive the benefits of parts A, B, and D. These include hospital insurance, medical insurance, and drug coverage. Specific in-network pharmacies may need to be used to ensure your insurer will cover the cost if you opt for this route. 

How to Join a Drugs Plan

Joining a drug plan is simple. If you’re searching for a new insurance policy, all you need to do is select it as an option (if available) during the selection process. Many independent and federal insurance companies will provide this choice.  

Alternatively, if you’re eligible for Medicare and want to enroll in Medicare prescription drug coverage, you’ll need to enroll in the Medicare Plan Finder. You can also call the Medicare agents to set up your drugs plan. If you want to add the cover later, you will need your Medicare number and the correct date your part A and B insurance began.

How to Find Out What Prescription Drugs Are Covered in Your Plan

If you want to find out what prescription drugs are covered in your current plan, you can head to your insurer’s website. Here you’ll be able to find the list of included medications in the provider’s policies. If the information isn’t transparent, then you should call your insurer directly for more details.

Drugs covered in your prescription policy should also be detailed in any materials mailed to you after setting up the insurance. If you have lost these, you can often request a new set to be sent to you.  

Other Important Factors to Be Aware of With Prescription Cover

What type of insurance you take out (HMO, PPO, or private) and what plan you purchase will determine how your drug policy works. 

Some may only allow you to use certain pharmacies. Others may not cover your current prescription. In the latter instance, you may be offered a one-time refill until your doctor prescribes a new drug that is eligible under your cover. Alternatively, you can apply for an exception. 

An exception will make the specific drug you use eligible for cover. However, you will often be charged copayment. The fee is usually the same rate as the most expensive drug already on the policies approved list. The amount may count towards your deductibles and out-of-pocket limits. 

If your request for an exception is denied, you can appeal this decision and seek a third-party review. 

You may also find that some policies cover shipping costs for delivering your prescription by mail. On the other hand, others may not offer this service within the plan and charge you an additional fee for it.

To Conclude

Don’t be afraid to pick up the phone and ask your medical insurer if prescription drug cover is part of your policy. You may be surprised by the number of medicines that are already covered in your plan. 

If a drug policy needs to be added on, it’s more than worth investigating further. You may incur a slight increase in premiums, so you would need to factor this into your budget.