People with health insurance are not immune to the high cost of prescription drugs. A Kaiser Family Foundation survey found that even among middle income, insured families, 25 percent of adults said that they or a family member had skipped doses of a prescribed medication because of its cost. Even if the medication you've been prescribed is not covered by your insurance plan, you can take steps to ensure that medication stays within your family budget.
Research the Reason for Denial
Your pharmacist may immediately know why the medication wasn't covered. The reason might be simple, for example, because the same or a similar medication has been prescribed too recently for the same individual. Another common reason is that the medication is not in the health insurance company's formulary (that is, the list of prescription medicines that has your health plan has agreed to pay for). If this is the case, call the toll-free number on the back of your health insurance card and ask if the insurance company covers a similar drug. Write down the name of the drug, as well as the name of the person you spoke to for later reference. You often can find this information on your insurance company's website as well.
Inform Your Health Care Provider
Call your health care provider, explain that the medication wasn't covered and ask what they suggest; if you are only going to be taking the medication for a short time, clinics sometimes have samples that they can provide to patients. However, if you need the medication for a chronic condition and it isn't covered because it isn't in your insurance company's formularly, ask if the similar drug the company does cover will work for you. If not, ask your health care provider to write a letter for you that states the prescribed medication is medically necessary. Use this letter to start the appeals process described in the plan handbook you were given at enrollment.
Search for the Best Deal
Comparison shop. Many consumers don't know that there can be a big price difference for the same medications at different pharmacies. Start with Walmart and Target affiliated drugstores first; both provide a number of generic drugs at just $4 for a month's supply.
If the medication is still not within your budget, contact the pharmaceutical company that makes it and ask if they have a patient assistance program that can provide the drug at a lower price. If you can't easily access this information or need assistance with the paperwork, use one of the prescription help clearinghouse sites listed in the resource section.
