How Do I Find Out What Drugs a Plan Covers?

Last updated: March 30, 2016

Using Formularies

Health insurers keep lists of which drugs are covered and which are covered at the cheapest cost for each plan. Any such lists are called formularies.

Drug cost-sharing is often “tiered”. This means you:

  • Pay less for a generic drug

  • Pay more for a brand-name drug and

  • Sometimes pay even more for a non-preferred brand-name drug

You should review the formularies in any plan they select. Make sure they meet your prescription drug needs. Find out what cost sharing any given drug requires.

For plans that use formularies, statements of benefits and coverage have an internet address for getting information on the plan’s drug coverage. The Health Insurance Marketplace has links to company formularies also. You can also call the health insurer for help.

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