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The Medicare Space Blog

A Quick Guide to Your Prescription Plan

4/26/2021

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​Prescription drug coverage is included with all health insurance plans, but not all medications are covered. And, based on the drug, the amount you'll have to pay for medicines within a program will vary. That is why it's essential to note how prescription drugs are covered and what to look for when choosing a plan.
Which Drugs Will Be Covered, and How Will You Know?
When comparing insurance policies, request a copy of the formulary, a list of the medications that cover. The health plan outlines how the drug's cost is distributed to you and the provider.

Tiers, or groups of drugs classified as per price, are standard in drug formularies. The level on which a drug falls determines your co-payment.

Each plan determines which drugs belong in which tier. While not all programs have the same number of tiers or have the same drugs, here's how they usually work:
  • Tier 1 — These are the cheapest prescription medications covered by the plan and are often confined to generics. Generic drugs are usually almost as effective as brand-name medications. The only difference is the name and the amount of cash that can save.
  • Tier 2 — In this tier, you'll find more costly prescription and brand-name drugs that your insurance plan has identified as "preferred." If you take a brand-name drug, talk to your Doctor over whether a medication is right for you. Your Doctor may prefer to give an alternative that has the same effect.
  • Tier 3 — This tier usually includes non-preferred and costly brand-name medications. You'll have to pay a lot of money out of pocket for these drugs.
  • Tier 4 — Last costly category is generally reserved for the most expensive drugs and those that treat rare diseases.

What Is the Formulary of a Plan?
Check the insurer's site for the formulary of a plan. Make a note of the plan's name, so you know which one to consider. If you can't find the info online, contact your provider and request a copy. If you are concerned about your formulary, such as what tier a prescription belongs to a level. You may call the insurance provider and ask for help.

Conclusion
The easiest way to prevent unexpected medication expenses is to understand what you're paying when it comes to health benefits. Make sure to double-check that any prescription medications you take are covered to avoid over the pocket payment.

At The Medicare Space, we put our clients first by offering them policies that they can afford. Having insurance is a necessity nowadays, and we're here to help you out. Learn more about our products and services by calling our agency at (866) 717-8683. You can also request a free quote by CLICKING HERE.
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