Prescription Drugs

Laurie asked her plan to approve a medicine she needed, because the medicine was not on the plan’s formulary.

Read Laurie’s story.

Not all health plans cover prescription drugs. If your plan does, usually your membership card will list your co-pays.

Topics on this page

• If you have prescription drug coverage
• Choosing a pharmacy

If you have prescription drug coverage

• Your plan usually has a formulary. This is the list of preferred drugs.
• If you want a drug that is not on this list, you must get pre-approval or pay for it yourself.
• Several times a year, the formulary is reviewed and may change. A new drug or a generic version of a drug may be added. Or a drug may be removed because new research has shown that the drug has a dangerous side effect.
• If your medicine is taken off the formulary, but you and your doctor think you still need it, your doctor can ask the plan to keep covering it for you.
• More information on prescription drugs.

Choosing a pharmacy

• If you have prescription drug coverage, you must get prescriptions filled at a pharmacy in your plan’s network.
• Compare prices at different pharmacies.
• Ask if the pharmacy has a computer program that keeps track of all the drugs you take. This can help you avoid problems with drug interactions.

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