What to do when a medication isn’t covered by insurance
My insurance doesn’t cover my prescription. Now what?
If you’ve ever brought a prescription to the pharmacy only to find out that the medication is not covered by your insurance, you’re not alone. According to a poll conducted by NPR, over 1/3 of Americans reported that their insurance plan would not cover a prescribed medication in the past year. For many, this could mean paying for prescription drugs out of pocket or not filling the prescription at all.
Finding out your prescription isn’t covered by insurance doesn’t have to mean going without your medication. Here are 3 ways to make sure you get the medication you need:
Talk to your doctor about generics or alternative medications
If you have health insurance, your plan comes with a formulary or list of covered medications. In most cases, your doctor won’t know every medication covered under your insurance plan’s formulary and could write a prescription for something not covered. There are simply too many different health plans.
Check your plan’s website or call your plan for a full list of covered medications.
If you have a prescription that is not covered, talk to your doctor about other options. Your plan may cover a generic or lower cost option. Remember, generic versions have the same key ingredients and work just as well as their brand-name equivalents.
Work with your health care provider to submit a prior authorization
A prior authorization (PA) is an agreement between a doctor and an insurance company that allows for medically necessary medications to be covered.
If a medication is not covered, it may still be available through a PA. With a PA, a doctor can contact the insurance company to see if it possible to get the medication covered. The insurance company typically will want to make sure you have tried cheaper alternatives first and that the medication is the best to use for your condition. The doctor and the insurance company will work together to find the best solution to make sure you can get the medication you need.
Pay out of pocket and save with Optum Perks
There may be times when you decide to pay for your medication out of your own pocket. With discounts from Optum Perks, you can save on most prescription medications. Simply search for the best discounts on hundreds of prescription drugs and save!
Formularies can change every year. Don’t give up if your medication isn’t covered. Talk with your health care provider about covered options or prior authorization. Don’t forget to try Optum Perks to help you pay less.