The Affordable Healthcare Act and Prescription Drug Coverage

iStock_000016017190XSmallA common complaint within the medical community is about the patients who are not faithful in taking prescribed medications. We know of people who do not take them because they are forgetful and we know people who are not faithful because they do not like some of the temporary side-effects. However, a chief reason is affordability for those patients who are uninsured and underinsured. One pill can equal a few days of groceries. However, the one missed pill can equal a life or the quality of someone’s life.

Here are some facts regarding prescription drug coverage and the new Affordable Healthcare Act:

  • All health plans for sale in your state’s marketplace must include prescription drug coverage.
  • Every state sets its own list of covered drugs called the formulary.
  • The formulary lists the names of drugs covered by its brand name and its generic name.
  • If you cannot find the medication you need on the formulary, then you can request it with your physician’s assistance in doing so and if the request is denied, you can appeal.
  • Many formularies have two payment methods. The two most common are coinsurance (a percentage) and co-pay (fixed amount).
  • Most formularies have three to four tiers of drug costs: generic, preferred, non-preferred and specialty.
  • You may have to pay a deductible.

Information about prescription coverage can be found in this one page guide on The Marketplace. Two additional resources are NeedyMeds.org and RxAssist.org.

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