Will my insurance cover my medications?

Whether or not your insurance will cover your medications largely depends on your specific plan and the medications prescribed to you. Typically, insurance companies have a formulary, which is a list of covered medications. This formulary may include both brand-name and generic drugs, but may also exclude certain medications that are deemed unnecessary or too expensive. In some cases, insurance plans may require you to use generic drugs or preferred brand-name drugs to help control costs.

When a prescription is sent to a pharmacy, the pharmacist will submit or bill the insurance company for the medication. If the medication is covered, the pharmacist will receive a paid claim and you will only be responsible for any co-pays or deductibles that apply. If the medication is not covered, however, the pharmacy will receive a denial and you may be responsible for the full cost of the medication. If the costs are too high, your clinician may be able to provide an alternative care plan.

Sometimes, insurance plans may require prior authorization before they will cover certain medications. This means that your healthcare provider will need to provide additional information to your insurance company to demonstrate that the medication is medically necessary. This information may include your medical history, lab results, and other relevant information. Once the insurance company has reviewed the information, they will either approve or deny the prior authorization request. If the request is denied, your healthcare provider may need to work with your insurance company to appeal the decision or find a covered alternative medication. It's important to note that the prior authorization process can be time-consuming, so it's important to start the process as early as possible to ensure that you can receive your medication in a timely manner.

Your Measured care team is here to help you through the prior authorization process.

In summary:

1. Whether or not your insurance will cover your medications depends on your specific plan and the medications prescribed to you.
2. When a prescription is sent to a pharmacy, the pharmacist will bill your insurance company for the cost of the medication and receive an approval or denial.
3. Insurance plans may require prior authorization before they will cover certain medications, which means that your healthcare provider will need to provide additional information to your insurance company to demonstrate that the medication is medically necessary.
4. Your care team will help you through the prior authorization process and, if necessary, can provide an alternative care plan.