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Choose Your Plan

Step 1: Find out if the health plan or PBM has a limited list of drugs
it will cover.

This is known as a formulary. If someone in your family takes medications for a chronic illness, such as high blood pressure, asthma, or diabetes, be sure those medicines are on the formulary before you select that plan. If they aren't, you will be expected to switch to different medications or pay the cost yourself.

Step 1

Find out if the health plan or PBM has a limited list of drugs it will cover.
Step 2

Find out how to file an appeal if insurance will not pay for the medicine you need.
Step 3

Find out how much you have to pay when you fill a prescription.
Step 4

Find out if the health plan has to pre-approve certain drugs before you can fill the prescription.
Step 5

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.