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Choose Your Plan

Step 4. Find out if the health plan has to pre-approve certain drugs before you can fill the prescription.

Many plans require your doctor to have prior authorization for some medicines before it will pay for them. That means your physician or pharmacist must call for permission to prescribe these medications. Some plans also require you to try a less expensive medicine before they will pay for the one your doctor might otherwise recommend. If you need a certain medication for a valid medical reason, you may be able to get it covered by filing an appeal. If you can't wait for the appeal process to finish, you may need to pay for the medicine yourself and then file an appeal to be paid back by the plan.