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.
Prescription Drugs and Covered California
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.
What’s the Cost of Prescription Drugs?
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.
Are There Prescriptions Drugs Not Covered by a Health Plan?
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.
Generic Prescription Drugs vs Brand Name
Patients often believe that brand-name prescription drugs are better than generic drugs – but, that isn’t necessarily the case.
Brand-name drugsThe obvious reason for many consumers to prefer a brand-name medication is that it is more familiar to them due to being advertised more frequently. These drugs have been developed by a pharmaceutical company that holds the patent and rights to sell them on the open market. Once those rights expire, other drug companies can copy the brand drugs into what is referred to as a generic version. Even with the generic copy available, brand name drugs are commonly usually more expensive.
Generic drugsA generic can be either a copy of a brand-name drug, or a brand-name drug with an expired patent. Both have the same active ingredients as well as a matching strength and dose. In fact, the U.S. Food and Drug Administration requires that all generic drugs be formulated to meet the same high standards for purity, quality, safety and strength as their brand-name counterpart. Typically, generic drugs are almost always the less expensive of the two.
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.