Real answers for your healthcare questions
How does prescription drug coverage work?
Answer
Prescription drug coverage helps pay for medications that are included on your plan's formulary. Your cost depends on the drug, its tier, the pharmacy you use, your deductible, and the plan's copay or coinsurance rules.
What to Know
Plans can place generic, preferred brand, non preferred brand, and specialty medications on different tiers. They may also require prior authorization, step therapy, or quantity limits. A medication can be covered but still have a high out of pocket cost.
What to Do Next
Before enrolling in a plan, search the formulary for every medication you take and check the preferred pharmacies. If a drug is not covered, ask about alternatives, exceptions, or appeal procedures.
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