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Prescription Benefits with Your Health Insurance Doesn’t Mean All Your Prescriptions Are Covered
The Affordable Care Act requires all health plans sold directly to individuals or through small employers to cover prescription medications. All health plans usually come with insurance coverage but not every plan covers every medication. And within a plan too, your copays will vary, depending upon the medication chosen. It is important to know about your plan’s coverage to avoid over paying for your medications.
Before deciding on a health insurance plan, ask for its formulary which is a list of medications that are covered by the plan, and also it will provide the guidelines on your copays. You can check your plan’s formulary on its website, or also ask your insurer to send you a copy.
Formularies usually have drug tiers or groups of drugs that are classified as per their costs. These include:
These are the least expensive medications and typically limited to generic medications.
This includes more expensive generic drugs and brand-name drugs that are termed as “preferred” by your plan. The tier contains the most affordable brand-name drugs.
It contains the non-preferred and expensive brand-name medications, and you will have to pay a significant amount as out-of-pocket expenses for the medications in this tier.
This contains most expensive medications that are needed for rare and life-threatening conditions.
The tiers may differ from plan-to-plan, as not all insurances have the same number of tiers or have the same drug in the same tier. Your copayment for a medication will depend on its tier or coverage status preferred or non-preferred.
Covered doesn’t mean all prescription costs are covered
Just because a medication is covered doesn’t mean that your insurance will pay for it. Pay special attention to whether your prescription will be covered by simple copay or you will need to fulfill your annual deductibles first. And if you are required to meet your deductibles, your plan will expect you to pay out-of-pocket for the full cost of your medication until you reach the threshold and it begins contributing towards your healthcare costs. But “covered” is a good thing as whatever you will pay as out-of-pocket will get you closer to the maximum you will need to pay for that year.
Find out how much you will have to pay for the medications in various tiers. Check with your insurance company if you need to use a pharmacy in their network, and if that’s the case; pick a pharmacy close to where you live.
Whether you have been prescribed the newest medication in the market or a generic that has been around for a long while, you count on your health insurance coverage to offset the cost of medications. However, even with covered medications, you may face a pharmacy denial for various reasons, such as:
- The medication is excluded as per your plan’s language
- You may have exceeded the maximum number of refills for that prescription
- You have exceeded your plan’s limitations
- Medication requires prior authorization
- A generic medication is required for generic only coverage, or
- Your medication has been processed at some other pharmacy.
What if you can’t afford a medication?
It is important to take the medication your doctor has prescribed to stay healthy and prevent the chances for future complicatons. However, if your face prescription medication affordability issues, such as its cost is higher than you expected, or you find yourself in a situation where you have to pay a significant amount as copay for high tier medications, or your medication has high deductibles and out-of-pocket expenses, or it is not covered by your health plan, then you can always use EzRx drug card to lower your cost of prescription medications and save on meds.
EzRx drug card to save on medications
EzRx drug discount card is good for prescription medications, including pets, over-the-counter medications and medical supplies. It can also be used for Albuterol discount card, Adipex drug discount card, flu vaccine discount card, or for that matter, as a general prescription savings card to save on medication costs with insurance as it can be used even if you have health insurance.
You can present both your insurance and EzRx medication discount card at the pharmacy, you may find some drug discount prices to be much lower than what you will have to pay as out-of-pocket with your insurance.
To maximize your prescription medications savings, check drug prices ahead of time on www.ezrxdrugcard.com for the lowest price, before presenting your prescription for filling at a pharmacy.
Get your EzRx digital drug card for prescription savings
EzRx prescription savings card can be used at over 65,000 participating pharmacies, including the brand-name chains such as CVS, Target, Kroger, Walgreens, Rite-Aid and Safeway to get up to 85% savings on drugs.
Getting your digital drug savings card is easy. Simply send the keyword “EZRX” to phone number 21000 to get your medications savings card on your mobile phone. The medications discount card is provided activated for free, without any upfront or renewal charges, and with lifetime validity. There are no income or age limits as well. It can also be used by friends and other family members.
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.