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Choose Your Plan
Step 2: Find out how to file an appeal if insurance will not pay for the medicine you need.
If the medicine you need is not on the formulary, you usually can file an appeal with the health plan to request that they pay for it anyway. You will not be told about your right to appeal when you are told that insurance will not pay, so it is important to find how to file an appeal on your own. You'll need to ask your doctor to provide information that explains why you need that specific medicine.
| Step 1
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Find out if the health plan or PBM has a limited list of drugs it will cover. |
| Step 2
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Find out how to file an appeal if insurance will not pay for the medicine you need. |
| Step 3
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Find out how much you have to pay when you fill a prescription. |
| Step 4
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Find out if the health plan has to pre-approve certain drugs before you can fill the prescription. |
| Step 5
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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. |
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