How does health insurance cover prescription drugs?

Health insurance coverage of prescription drugs varies from plan to plan in California. Some plans may cover all prescription drugs, while others may not. Generally, most health plans will cover a certain percentage of the cost for medications that are on their formulary. This means that the plan has determined that these medications are medically necessary and will usually require you to use a plan-preferred source in order to purchase the medication. In addition, some plans may require prior authorization from the health insurance company in order for the medication to be covered. This means that the health plan would want to review why you need the prescription drug and what kind of treatment it is expected to provide before they will approve it. On the flip side, some health plans may also have copayment or coinsurance requirements for certain medications. This means that you will have to pay a certain amount of money before the drug is covered. The amount that you have to pay could be a certain dollar amount or a percentage of the total cost. Lastly, some health plans may require you to get the medication through a mail-order pharmacy if the cost is less than if you purchase it through a retail pharmacy. This helps both you and the health plan save money. In summary, prescription drug coverage for health insurance plans in California varies from plan to plan and you should speak with your doctor and health plan to find out what medications are covered and what costs are associated with filling your prescriptions.

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