QUESTION

How can I find out if a health plan covers the prescription drugs that I take?

Individuals with no coverage | Comparing Plans: Benefits and Costs
ANSWER

Health plans in the marketplace must include a link to their prescription drug “formulary” (a list of covered drugs) with other on-line information about prescription drug coverage such as tiering structures and whether any restrictions exist to accessing covered drugs. The formulary should be easily accessible meaning that it can be viewed on the health plan's public web site through a clearly identifiable link or tab without creating an account or entering a policy number. The health plan must provide the formulary for the health plan and not a general list for the insurer. If you don’t find your drug on the formulary but your doctor says it’s medically necessary for you to take that specific drug, you can apply for an exception to the plan formulary. A prescription look up tool is also available on HealthCare.gov for consumers to determine whether or not a health plan covers a prescription drug. (45 C.F.R. § 156.122).

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