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Medication Insurance Coverage
  • Posted On: September 25, 2019
  • By: admin
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What To Do When Your Medication is Not Covered?

How many of you have spent over two hours at the doctor office received a needed prescription, then gone to the pharmacy and told it was not covered by the insurance? This happens all to often and is frustrating for all of us. After paying for the doctor’s visit the medication you need is too expensive! With our insurances constantly changing it is difficult to know what will be covered from month to month.

What medications are often excluded from insurance coverage?

A drug may be excluded from the formulary or drug list for a variety of reasons such as:

  • There might be a less expensive drug that works just as well.
  • There may be less expensive generic medicine available for a brand-name drug.
  • It is a non-covered medication class (Birth Control, Acne, Weight Loss, Erectile Dysfunction)

If a medication is non-formulary, it means it is not on the list of covered drugs. To check whether a drug is covered by your insurance plan, you can visit your insurance companies website to review the prescription drugs covered or call your insurance provider directly. You can also get a summary of benefits and coverage from your insurance provider.

Following categories of medications and products are usually not covered by Medicare plans under the Part D benefits:

  • Drugs for cosmetic purposes
  • Drugs used to treat anorexia, weight loss, or weight gain
  • Prescription vitamins and mineral products
  • Fertility promoting drugs
  • Non-FDA approved products
  • Drugs for relief of cough and cold symptoms
  • DESI (drug efficacy study implementation) drugs that are determined to be safe by FDA but not effective
  • Bulk chemicals, devices and medical supplies
  • Drugs used to treat erectile dysfunction

Below drugs are currently excluded from most coverages

Analgesics: Cambia and Sprix Nasal Spray

Cardiovascular: Zypitamag

Neurological: Ajovy

Respiratory: Alvesco, AirDuo Respiclick, Proventil HFA,

Musculoskeletal: Amrix

Gastrointestinal: Motofen, Zorvolex, Trulance, Pancreaze

Acne: Retin_A, Epi-Duo, Clindamycin, Erythromycin, Adapalene, Benzoyl Peroxide, isotretinoin (Amnesteem, Claravis

Weight Loss: Phenteramine (Adipex), Contrave, Orlistat

Cosmetic: finisteride, Brimonidine (Mirvaso) and oxymetazoline (Rhofade)

Vitamins: Cholecalciferol (vitamin D3) 50,000 units, Vitamin D-2, ferrous sulfate, calcium, prenatal vitamins

ED: avanafil (Stendra), sildenafil (Viagra) tadalafil (Cialis), vardenafil (Levitra, Staxyn)

Allergy Medicaitons: Loratadine (Claritin), fexofenadine (Allegra),  Cetirizine (Zyrtec)

What if you can’t afford a medication you are discharged on?

If your coverage has changed, talk to your doctor if a covered alternative might work for you, or you may use EzRx discount drug card to help cover the cost of medications not included by your coverage. Always keep the EzRx Drug Discount card handy.  If you are denied a drug at a pharmacy due to coverage exclusion, or if you copay is just to high, you can present the EzRx Drug Discount to see how much you save.

With EzRx discount drug card, discounts range from 10% to 90% depending on the pharmacy and medication being prescribed. The drug card is a good option for purchasing medicines not covered by insurance plan or the purchases of medications with high copays and deductibles at a discounted price. EzRx drug discount card is for everyone, there are no age limit or income criteria. It is provided free of cost and there are no annual renewal charges or limits on drug purchases. EzRx drug card can be used by your family members and friends as well.

To get your digital EzRx drug card in your mobile, just text “EZRX’ to 21000. EzRx discount drug card is accepted at our 65000+ network pharmacies. You can check drug prices at the along with details of their estimated retail price, discount and percentage savings with EzRx drug card. It’s not unusual for our network pharmacies to sell drugs at a much lower price than some customers pay for co-pays or mail-order prescriptions.

What To Do When Your Medication is Not Covered?

Disclaimer: The information and content posted on this website is intended for informational purposes only and is not intended to be used as a replacement for medical advice. Always seek medical advice from a medical professional for diagnosis or treatment, including before embarking on and/or changing any prescription medication or for specific medical advice related to your medical history.

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