Covered California Prescription Drugs

Since the passage of the Affordable Care Act, health insurance plans are required to include 10 essential health benefits. Prescription drug coverage is one of those 10.

Health insurance plans under Covered California cover many prescription drugs, also referred to as prescription medications with varying prices to the enrollee. Though it might be confusing, the set of prescription drugs covered by health insurance plans can be called by different names, including a formulary, prescription drug list, outpatient prescription drug list, or select drug list.

To find the prescription drug lists for each Covered California health insurance plan, you can contact a friendly Freeway Insurance agent or go directly to the Covered California website

Most people are aware that generic drugs are the cheapest, followed by preferred drugs – while non-preferred brand drugs and specialty drugs are by far the most expensive. What your doctor prescribes may or may not be covered by your health insurance plan. The dollar amount you pay will depend on your plan and its copay.

In addition, should a drug have a deductible in effect, the entire deductible must be met before the copay or coinsurance amount applies. It must also be noted that with all health insurance plans, a maximum limit for out-of-pocket costs exists. Therefore, once the enrollee has reached the limit according to his plan, the insurance company will then pay 100 percent of the covered drug’s cost.

However, to receive prescribed drugs at the policyholder price, the enrollee must purchase them through a participating pharmacy or a mailing program in their chosen health insurance plan’s network.

For a list of medications that a plan doesn’t cover, enrollees should contact their health insurance plan’s customer service department and inquire about a specific needed medication. Be ready to describe the exact Covered California health insurance plan you’re on and the name of the drug. If that medication is not available, they may inform you of a generic equivalent or substitute along with associated out-of-pocket costs.

Because prescription medications are continually added or removed from lists, the enrollee may want to confirm coverage and potential out-of-pocket cost with their assigned health insurance plan before proceeding with the filling of prescriptions.

Patients often believe that brand-name prescription drugs are better than generic drugs – but, that isn’t necessarily the case.

If you’re currently uninsured and require prescription medications, don’t let the Covered California open enrollment for 2021 slip past you. You have until January 15, 2021.