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Knowing Whether Your Health Insurance Will Cover Brand Name Drugs

2010-10-06

You can find many aspects of your health insurance coverage online. Not only are the basics of your policy, such as copayments and deductibles, provided through online information, but you can also find specific physicians that accept your plan and information about coverage for name brand prescription drugs. Many times, to cut costs, insurance companies will require substitution of generic equivalents for name prescription drugs. For many patients, though, this substitution means receiving a prescription with a different chemical makeup, which could prove ineffective to treat their condition.

Checking your health insurance coverage online to determine whether your plan covers name brand prescription drugs might be more complicated than clicking on the link labeled as having that information. Most likely, you will have to search through the entire prescription coverage database to find the specific drug you are investigating and then check whether there is a generic equivalent. Moreover, you will also have to search for any contractual obligations you may have to try a generic drug prior to the insurance company paying for a name brand prescription drug.

Next, you should check your general prescription coverage policies. Depending on your company, it might be written into your policy contract that if a medication has a generic equivalent, you will be provided the generic. However, sometimes this rule is avoidable if your physician writes that the name brand is medically necessary. In this case, a pharmacist would be required to fill your prescription with the name brand and not the generic.

If a generic does not exist, or even if your physician requires that you be provided with the name brand drug, your insurance may still refuse to pay for the drug. In the former instance, it is not unusual for insurance companies to require you to try other, similar medications prior to paying for the name brand medication. In the latter situation, the company may treat your physician's directions as a refusal to take the generic equivalent, thereby relinquishing it from its duty to pay for your prescription altogether. In either situation, you could be required to pay for the entire medication out of pocket or be subjected to a higher copay amount for the name brand prescription drug.

It may not be possible for you to determine whether your insurance company will pay for name brand prescription drugs simply from its online database, particularly in light of the aforementioned occurrences. Knowing whether your prescription will be covered, even partially, by insurance may affect your decision to fill the prescription at all; by starting with your insurance company's online database, you can be on your way to knowing just how hard hit your pocket will be.

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