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Choose Your Plan: Make an Informed Decision
Asking the right questions is key to getting the most appropriate medicines for you and your family and in limiting your costs.
When choosing a health insurance plan, making sure the medicines you take regularly are covered is just as important as knowing that your doctor is covered. Knowing how to select the right prescription coverage for you and your family is important to maintaining and restoring your health.
While most health insurance pays for prescription medicines, the rules for pharmacy benefits are often different than for other medical benefits. For example, your prescription claims may be handled by a pharmacy benefit manager, or PBM—not by your insurance company directly.
When making decisions about your health insurance, always look at the impact the decision may have on your access to the medicines that members of your family are currently taking.
By following these simple steps, you can ensure that the prescription coverage you choose will be the best fit for your needs.
Find out if the health plan or PBM has a limited list of drugs it will cover.
Find out how to file an appeal if insurance will not pay for the medicine you need.
Find out how much you have to pay when you fill a prescription.
Find out if the health plan has to pre-approve certain drugs before you can fill the prescription.
Find out if you will be able to choose to get your prescriptions filled at a local pharmacy or if you will have to use a mail order service.