Check the formulary first
Every plan maintains a "formulary" — the approved list of medications it helps pay for. A drug not on that list may still be available to you, but usually at a much higher price. Before enrolling, confirm your current medications and dosages are listed.
How to check what's covered
- Review the prescription list on your insurer's website.
- Pull your plan's Summary of Benefits and Coverage, available from the insurer or your Marketplace account.
- Call the insurer directly — have your plan ID ready, found on your insurance card or account.
In-network pharmacies
Just like doctors, pharmacies can be "in-network" or not, and that changes what you pay. Call your insurer or check their site to confirm your regular pharmacy is included — if it isn't, ask which nearby pharmacies are. Many plans also offer mail-order delivery for maintenance medications, which is often cheaper and more convenient.
Don't assume a high price is permanent. We've seen a $500 medication become a $20 copay once a client moved to the plan that actually covered it. It's worth having an agent check before you buy.
Not sure your medications are covered?
Send us your prescription list and we'll check it against real plan formularies.