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An Overview of Prescription Drug Coverage | RMHP Blog

An Overview of Prescription Drug Coverage | RMHP Blog



How to Find the Prescription Drug Coverage That’s Right for Your Needs

Choosing the right coverage for your healthcare needs is important, especially since prescription drug prices tend to increase every year.

Many health insurance plan comes with prescription drug coverage. However, the extent of this coverage can vary from plan to plan. Here’s what you need to know about prescription drug coverage before you choose a health insurance plan.

What is the formulary?

A formulary is a list of prescription medications covered by insurance. It’s important to review this list to determine whether or not your prescription medications are covered under the plan.

If your prescription medication is not covered, this could be because an alternative, less expensive medication that treats the same condition is included in the plan. For example, high blood pressure medication A may not be covered by the plan, but high blood pressure medication B, which costs less, may be covered. Contact the health plan and ask about any of these questions that you might have.

How much will you have to pay for prescription medications?

The prescription medications listed in the formulary are usually divided into tiers, which determine how much a medication costs. The lower the tier, the less you will pay for the medication.

The number of tiers and medications included in each tier will vary depending on the plan. For example, many people choose generic medications because they are just as effective as brand name medications, but far more affordable. These low-cost, generic prescription medications are often found in tier one, whereas high-cost, brand-name prescription medications are typically found in higher tiers.

Before choosing a plan, find out which tier your prescription drug falls into so you have a better idea about the cost.

Some health insurance plans will have a prescription drug deductible that is separate from the medical deductible. This means you will have to pay for prescribed medications until you meet your prescription drug deductible, which is when your health insurance will start covering these expenses.

Are there any restrictions on your prescription medications?

Each plan’s formulary will also tell you whether there are any restrictions on your prescription medications.

A plan may require prior authorization from your provider for certain prescription medications. When prior authorization is required, your provider will need to tell your insurance company why you are taking the medication. After receiving this information, the insurance company will decide how your plan will cover the medication.

Some health insurance plans also establish quantity limits for certain medications. A quantity limit specifies the largest quantity of medication that will be covered per copayment or in a set timeframe. The insurance plan will not cover the additional medication cost if you need more than this limit.

Working through quantity limits and prior authorizations can take a little extra time in getting your prescriptions filled, so being aware of any these limits can help with your planning.

Where can you go to get your prescriptions filled?

Look at the list of in-network pharmacies before choosing a health insurance plan. Your prescription drug coverage will only cover medications filled and purchased at these pharmacies.

Some health insurance plans will only allow you to fill prescriptions through mail-order pharmacies. Other insurance companies, including Rocky Mountain Health Plans (RMHP), have plans that provide for both pharmacy pick-up and home delivery.

Review each plan to determine how and where you can get your prescriptions filled and see if your preferred pharmacy is on the list.

These are some of the many factors to consider when choosing the right prescription drug coverage and health insurance plan for you.

Have questions? RMHP’s knowledgeable, Colorado-based support teams are here to help. Contact us today to get the answers you need to choose the right plan for you.