Jaycee Brown

Jaycee Brown

Director of Communications

Prescription Coverage

Many doctors prescribe drugs to patients in order to treat their illnesses, conditions, conditions after surgery, etc. However, some patients are unable to afford them. A national poll from NORC at the University of Chicago and the West Health Institute shows, “About one in three respondents said they did not fill a prescription, or took less than the prescribed dose, to save money” (Lagasse 2018). Patients could obtain prescription coverage from a variety of sources. Particularly, health insurance policies have caveats on prescription coverage.
Patients can receive coverage for prescriptions through a variety of ways. The Affordable Care Act requires health insurance to provide coverage for prescription drugs (Masterson 2017). Patients could also get coverage for prescriptions from Medicare by “[joining] a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered” (“How to get drug coverage”). People can get Medicare Prescription Drug Plan (Part D), which “[adds] drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans” (“How to get drug coverage”). They can also receive prescription coverage from Medicare Advantage Plan (Part C), which is “like an HMO or PPO,” or other Medicare health plans (“How to get drug coverage”).
Prescription coverage in health insurance policies contain some rules. Health insurance plans have networks of pharmacies that people can go to for their prescriptions (“Getting prescription medications”). People should view the companies’ formularies, which contain the companies’ “preferred drugs for coverage” (Insurance.com 2011). If the drug they need is not on the formulary, then they would “pay more out of pocket…” (Insurance.com 2011). In this case, patients should look into “[buying] a standalone prescription drug plan” (Insurance.com 2011). Although people receive coverage for the drugs in the formulary, “[others] may be covered only for treatment of specific conditions or after [they’ve] tried a different, preferred drug first” (“What You Need to Know About Prescription Drug Costs and Coverage” 2016). Some insurance policies partly pay for drugs with some out-of-pocket costs for the patients before the patients pay their deductibles (“What You Need to Know About Prescription Drug Costs and Coverage” 2016). Other policies cover prescriptions once patients pay their deductibles (“What You Need to Know About Prescription Drug Costs and Coverage” 2016). Others may partly cover prescriptions after patients pay “a special prescription drug deductible” (“What You Need to Know About Prescription Drug Costs and Coverage” 2016). Furthermore, some insurance companies may determine the amount of coverage for prescription drugs based on how they classify them on different tiers (“What You Need to Know About Prescription Drug Costs and Coverage” 2016).
Patients receive prescriptions from different types of doctors, including dentists. Prescription drugs may be costly for some patients, but they can utilize prescription coverage to help pay for them. They have to make sure the insurance companies cover their prescriptions as well as check for any deductibles, out-of-pocket payments, and more.

Works Cited
“Getting prescription medications.” HealthCare.gov. Accessed March 29, 2018.
“How to get drug coverage.” Medicare.gov. Accessed March 29, 2018.
Insurance.com. “What is prescription insurance and how much does it cost?” insurance.com,
January 1, 2011. https://www.insurance.com/health-insurance/faq/prescription-insurance.aspx.
Lagasse, Jeff. “As healthcare spending and costs rise, Many Americans are going without
necessary medical care.” Healthcare Finance, March 26, 2018. http://www.healthcarefinancenews.com/news/healthcare-spending-and-costs-rise-many-americans-are-going-without-necessary-medical-care.
Masterson, Les. “Different Types of Health Insurance Plans: Learn How to Compare.”
insurance.com, September 27, 2017. https://www.insurance.com/health-insurance/health-insurance-basics/all-you-need-to-know-about-health-insurance.aspx.
“What You Need to Know About Prescription Drug Costs and Coverage.” eHealth, October 7,
2016. https://resources.ehealthinsurance.com/affordable-care-act/need-know-prescription-drug-costs-coverage.


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