Prescription Drug Coverage
Medications are essential to managing your health, but costs can add up quickly. Our prescription drug coverage helps you afford the medications you need to stay healthy.
Medications are essential to managing your health, but costs can add up quickly. Our prescription drug coverage helps you afford the medications you need to stay healthy.
Nearly 66% of American adults take at least one prescription medication, and for many, these medications are essential for managing chronic conditions, preventing serious health complications, or treating acute illnesses. Without insurance coverage, prescription drug costs can be staggering, with some specialty medications costing thousands of dollars per month.
The consequences of being unable to afford medications are serious. Studies show that millions of Americans skip doses, cut pills in half, or abandon prescriptions entirely due to cost. This medication non-adherence leads to worsening health conditions, preventable hospitalizations, and even premature death. Comprehensive prescription drug coverage is not just a financial benefit but a critical component of maintaining your health.
Our health insurance plans include robust prescription drug benefits designed to make your medications affordable. From common generic drugs to specialty medications for complex conditions, we help you access the treatments your doctor prescribes without breaking your budget.
Low-cost generic drugs with minimal copays, typically $5-$15 per prescription. Generics contain the same active ingredients as brand-name drugs at a fraction of the cost, available at thousands of pharmacies nationwide.
Coverage for preferred and non-preferred brand-name medications when generics aren't available or aren't appropriate for your condition. Copays vary based on the drug tier but remain predictable and manageable.
Convenient 90-day supplies of maintenance medications delivered directly to your door, often at reduced costs compared to monthly fills. Ideal for ongoing prescriptions you take regularly.
Coverage for high-cost specialty drugs that treat complex conditions like cancer, rheumatoid arthritis, multiple sclerosis, and hepatitis C. Specialty drug management programs help coordinate care and reduce costs.
Access to over 60,000 pharmacies nationwide, including major chains like CVS, Walgreens, Walmart, and Rite Aid, plus local independent pharmacies. Fill prescriptions wherever is most convenient for you.
Predictable copays that help you budget for your medications. Our tiered copay structure ensures you always know what you'll pay, with the lowest costs for generic drugs and progressively higher tiers for brand-name and specialty medications.
The lowest-cost tier includes FDA-approved generic medications that are therapeutically equivalent to brand-name drugs. Most common prescriptions fall into this category, including medications for blood pressure, cholesterol, diabetes, and many antibiotics. Expect copays of $5-$15.
Brand-name medications that have been identified as providing the best value and effectiveness within their drug class. When a generic isn't available, preferred brands offer the next most affordable option with moderate copays typically ranging from $30-$50.
Brand-name drugs that are effective but have preferred alternatives available. You may choose these if preferred options don't work for you or your doctor specifically prescribes them. Higher copays apply, typically $60-$100, encouraging use of lower-tier alternatives when appropriate.
High-cost medications used to treat complex, chronic conditions. These often require special handling, administration, or monitoring. Coverage includes coinsurance rather than flat copays, with patient assistance programs available to help manage costs.
Even with good insurance coverage, there are strategies to minimize your out-of-pocket costs for prescription medications:
Always ask your doctor if a generic version is available. Generic drugs are just as safe and effective as brand-name medications but cost significantly less. Your pharmacist can also suggest generic alternatives and contact your doctor for approval.
For medications you take regularly, mail-order pharmacy typically offers a 90-day supply for the price of two monthly copays, providing significant savings over time while adding the convenience of home delivery.
Your plan's formulary lists all covered medications and their tiers. Before starting a new medication, check if it's on the formulary and discuss alternatives with your doctor if a more affordable option exists in the same therapeutic class.
Many pharmaceutical manufacturers offer patient assistance programs that provide medications at reduced cost or free for those who qualify. Our member services can help you identify and apply for these programs for expensive specialty medications.
A formulary is a list of prescription drugs covered by your health insurance plan. It organizes medications into tiers based on cost and clinical effectiveness. Using formulary drugs ensures you receive coverage; non-formulary drugs may not be covered or may require prior authorization.
If your medication isn't covered, your doctor can request an exception or prior authorization. Alternatively, your doctor may prescribe a covered alternative that treats your condition effectively. Our member services team can help navigate this process.
Yes, prescription drug costs typically count toward your annual deductible and out-of-pocket maximum. Some plans offer copays for certain drug tiers before the deductible is met, while others require you to meet the deductible first. Check your specific plan details.
You'll get the lowest prices at in-network pharmacies, which include most major chains and many independent pharmacies. Out-of-network pharmacies may have higher costs or may not be covered at all. Our provider directory lists all in-network pharmacies near you.
Maintenance medications for chronic conditions like diabetes, high blood pressure, and high cholesterol are covered with predictable copays. We encourage using mail-order pharmacy for 90-day supplies, which reduces costs and ensures you never run out of essential medications.
Stop overpaying for prescriptions. The right health insurance plan can save you hundreds or even thousands of dollars annually on the medications you need. Our licensed agents will help you find a plan with prescription drug coverage that fits your needs and budget.