Important Things to Know About Your Drug Prescription Coverage and Your Rights

Prescription drugs play an important role in the lives of millions of people all over the world. In the USA alone, there are more than 4 billion prescriptions dispensed annually. Many people rely on prescription drugs to live a healthy and happy normal life.

People of all ages use prescription drugs, but they are especially important to people as they age. As we get older, we become more susceptible to certain illnesses and ailments, that may require prescriptions to keep under control. There are dozens of different prescription drugs out there that help a wide range of different issues.

In addition to knowing the particular drug you need, you also need to be familiar with the type of drug coverage you have. It is incredibly important to know the ins and outs of your prescription drug plan.

Without any further ado, let’s go over some important things that you need to know about your particular prescription drug coverage.

What Drugs it Covers


Of course, the primary thing to know about your plan is whether or not it covers the prescriptions you need. If it does, it will save you a lot of money. On the other hand, if it doesn’t you will not only be wasting money on a plan you don’t use, but will still need to pay full price for your drugs.

The best way to see what is covered is to look at the formulary, which is simply a list of every prescription drug that is covered by your plan. This formulary will generally categorize drugs into tiers 1-4, based on their costs.

Not all categories are the same from one company to another, so always look closely at what is covered and what tiers your drugs are in. Finding the formulary should be simple, as most insurers will have it on their website to easily be found and searched.

You can also check out your summary of your benefits and coverage, to get an overall look at what is covered. If you cannot find or see your summary, and their website doesn’t provide the list, don’t hesitate to call your insurer directly. They will generally be able to assist you over the phone and make sure that your plan covers what you need it to.

Also, it is important to know that plans can change the list of drugs that they cover. As a result, you should be sure to check the formulary annually to ensure the drugs you require are still covered in the plan.

What the Costs Are


After making sure your drug coverage actually covers the things you need, the next most important aspect of the plan is how much it will cost you. As you could imagine, drug plans can run the gamut in terms of costs. Some can be relatively affordable, while others can be more expensive.

In general, there are a few different costs you will be responsible for making to pay for your prescription drug coverage. These include premiums, your deductibles and copayments. While there are other potential costs that some may need to think about, these three are the most common.

Your premium will essentially be your ongoing monthly fee that you pay for coverage. Your deductible is the amount you will pay every year for prescriptions before your insurance begins to pay its share of the cost. Not every plan has a deductible, and for 2024, the deductible cannot be more than $445.

The copayments are the amounts you are responsible for paying after your deductible has exceeded. You will pay your share, and the insurer will pay theirs. The amount varies from plan to plan, but also based on the tier level of your drug.

As touched on earlier, the exact amount of each of these costs will depend on your plan and insurance provider. If you have any questions about the costs or feel you are being charged an incorrect amount, be sure to reach out to your provider.

Which Pharmacy Can I Visit To Fill My Prescription?


Another very important thing to know is which pharmacy you can visit to fill your prescription. While you might think that you can visit any pharmacy to get your prescription refilled, this might not be the case. Similar to how different health plans will cover different drugs, different plans will often work with different pharmacies.

Many plans will have a network of pharmacies that they work with to provide you with discounted prescription drugs (which are called “in-network). In many cases, you can still work with other pharmacies, but they will be more expensive.

So before you go get your prescriptions filled at a pharmacy at random, do some research to ensure that the pharmacy you use is indeed in their network. If it’s not, you will need to begin using another pharmacy to get your prescription drugs affordably.

Your Rights When it Comes To Your Prescription Drug Plan

In addition to knowing your prescription drug coverage well, you should also know your rights when you have a Medicare prescription drug plan (check HealthMarkets for more information). This can help you ensure you are not being taken advantage of and are being treated fairly. You have the right to file a complaint, the right for your prescription drug information to be kept private, and always get a written explanation for any changes or decisions related to coverage.

Of course, you also have the same rights as everyone else with Medicare such as being protected from discrimination, being treated with respect, having your information be kept private and get information in a way that you can understand. These are only a few of the rights, so be sure to familiarize yourself with them, as well.

If you are still concerned about your rights or have a question about something, be sure to call your plan provider to get the answers or assistance you need.

In conclusion, we hope this article has helped you learn some important things to know about your prescription drug coverage and your rights.

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