Prescription Drug Insurance and Drug Safety

Millions of Americans rely on prescription medication to help them maintain their overall wellness. As a result, major health insurance plans almost always cover these services. However, no two prescription drug plans are identical. It’s important to both understand how your plan covers these drugs and be a responsible consumer once you begin taking these medications. Prescription drug safety is nothing to take lightly.

Prescription Drug Coverage Under Health Insurance

Under regulations set by the Affordable Care Act, most health insurance plans available in the United States must offer a set of essential benefits, including prescription drug coverage. With this coverage, your insurer will agree to pay a significant portion of the cost of numerous prescription drugs. Therefore, you will only be responsible for paying a portion of this cost out of your own pocket.

Obtaining, paying for and Taking Your Medicine

Health insurance for prescription drugs is not unlimited. Therefore, you must work within the terms of your plan to receive the most optimized coverage for your medications. Several terms and conditions might apply.

  • There are thousands of prescription drugs on the market, and most insurance plans include formularies that list which of these they will cover. They will usually offer numerous drugs to treat the same condition.
  • If your formulary does not cover a certain drug, then your doctor can choose to appeal to the insurer to have it covered.
  • Plans usually separate drugs into tiers. Drugs on the lowest tiers are usually generics that have the most affordable prices. Those in higher tiers might be specialty medications or brand-name drugs that come at higher costs.
  • Often, your insurer will have a pharmacy network that lists the pharmacies that will fill your prescriptions at optimized prices. There are numerous specialty and retail pharmacies included within most plan networks.

Once you get your prescription, it is of course your responsibility to understand that you are now in possession of a substance that could be harmful to you if you use it incorrectly. You must take your medication only as prescribed by your doctor, and you are not permitted to share medications with or sell them to others.

Additionally, it’s to your advantage to review your medications with your doctor periodically, to gain a better understanding of the side effects of these medications, how they are benefitting you, and whether you might need to make changes to dosages or switch medications altogether. Luckily, your health insurance will also enable you to receive at least an annual checkup with your doctor, and this is a perfect time to review your prescription medication needs for the coming year.