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A national 501 (c)(3) non-profit charity that provides direct services to patients with chronic, life threatening and debilitating diseases to help access care and treatment recommended by their doctor.
Health insurance plans are complicated things. Each plan offers different levels of coverage and the actual cost to you can be buried under mountains of forums, lists and paperwork or easily confused. Things get even more complicated when you look deeper into each plan based on your medication needs.
When you coverage beings, you can go to your health insurance plan’s website and view your formulary there. Insurers have a requirement to make this information available during open enrollment as well, so you can also view a copy during your plan decision process.
Each health plan allows you to get your medications from different approved pharmacies called in-network pharmacies. To find out what pharmacies are considered in-network, you can call your insurance company using the number on the back of your card or visit your insurer’s website.
One of the biggest healthcare barriers patients hit can be navigating the details of their prescription drug coverage options. If you know that you’ll need prescription drug coverage, it is important to research and choose a plan that covers your medication. Under a healthcare plan, the list of covered prescription drugs is called a formulary. The formulary is usually divided into tiers or levels of coverage based on the type or usage of the medication. Each tier will have a defined out-of-pocket cost that the patient must pay before receiving the drug. During your research, you’ll want to ensure that…
The formulary shows each covered medication’s place within a number of tiers or categories defined as part of your plan’s pharmacy benefits. The actual number and name of the tiers varies by health plan. Each tier represents a different amount you will have to pay for the drug as part of your out-of-pocket expenses.
When crafting a drug formulary, every individual health insurance provider will use its own committee of pharmacists and physicians to determine what drugs are covered and how much they will cost. This variety leads to each health provider’s drug formulary being unique.