Medication-Related Barriers

Navigating the plan’s Medication List and Drug Formulary

Medications can be a large financial barrier for patients, especially if dealing with a chronic or life-threatening condition. To protect yourself, when prescribed a medication, compare the medication to your insurance plan’s drug formulary to ensure the medication is on the approved covered list, and that you are aware of the out-of-pocket costs that need to be paid in order to receive the prescription.

If your prescribed medication is not covered on the plan formulary:

• • Talk to your doctor about whether a different medication that is on the formulary is an option in your situation

• • Consider switching to the generic version of the drug if possible

• • Formally request an exception to the formulary list. This is processed in conjunction with the prescribing provider and includes documentation supporting the medically necessary reason for you to take a non-formulary medication to treat your condition. If this is not approved, you would be responsible to pay the full cost if you chose to proceed.

• Seek out co-payment programs, charity assistance or financial help from the drug manufacturer to help pay for medications.

You may be required to try other medications in the same class before you can be approved for a name brand drug, also known as step therapy.