How to See if Your Healthcare Plan Covers Your Prescriptions

There are many reasons why you’d want to look out if your insurance plan covers your medication prescription. If you’re looking around for a new insurance plan and it’s important to find out if your current medications are covered.

Maybe your healthcare professional just prescribed an alternative medication and you would like to see it before you choose the insurance policy. While this information is searchable, it does require some skill to find it. We will help you through this article.

Whenever doctors prescribe an expensive form of medication, the first thought in your mind is if your insurance plan covers the cost. Or even you would like to understand what tier a drug is in, or whether it is a preferred or non-preferred brand.

You have different options for getting this information. We’ll assist you in understanding where to look for it.


Does my new insurance plan cover my prescription?

Follow the following steps to figure out the prescriptions covered under your new Marketplace plan:

  1. Visit your insurer’s website to review an inventory of prescriptions your plan covers
  2. See your Summary of advantages and Coverage, which you’ll get directly from your insurance firm, or by employing a link that appears within the detailed description of your plan in your Marketplace account.
  3. Call your insurer to inquire what’s covered. Have your plan information available. It all available on your insurance card, the insurer’s website, or the detailed plan description in your Marketplace account.
  4. Check out any details your insurance firm sent you for the coverage you have got


Summary of Benefits and Coverage (SBC):

This document may be a summary of what the health plan covers. While the formulary doesn’t actually tell you ways much different tiered drugs will cost you, the SBC will outline what quantity your copay is for every tier.

When you’re buying healthcare plans or determining whether to stick or to not stick with your current one, use the formulary and SBC to search out whether a selected medication is covered. Based on an example of a tier 3 medication such as insulin SBC, is to be considered a “non-preferred brand”, meaning that you simply need to pay 40% of the drug’s cost. When choosing a health plan option, it’s important to get one with a cheap premium provider (the amount you buy insurance every month) and also consider which plan has the simplest coverage and possibly the lowest out-of-pocket expenses for your medical needs.

During open enrollment periods (the time people are buying new plans, insurance companies are required to form list of medicines and SBCs available. It’s your right to request a list of medicines for an idea you’re buying.


Can I attend my regular pharmacy to urge my medication?

Just like different health plans cover different medications, different health plans allow you to buy your medications from different pharmacies (called “in-network pharmacies”). Call your insurance firm or visit their website to seek out whether your regular pharmacy is in-network under your new plan and, if not, what pharmacies in your area are in-network. You’ll also learn if you’ll get your prescription delivered within the mail.

If you’ve got additional questions, call 800.858.1772 to get the required information.


Prescription Drugs

Prescription Costs Keep Going Up – How Can You Save?

It’s a problem we’re all getting to know very well. Prescription costs keep rising, and it can often feel like there’s nothing any of us can do about it. 

The beginning of 2020 continued the trend, with more than 1,200 drugs’ prices increasing by an average of 5-6 percent and 20 generic drugs increased by an average of 29.4 percent, according to And the consequences are clear. In study after study, it’s estimated between 20 to 30 percent of prescription medications are never filled and up to 50 percent of medications for chronic illness are not taken consistently, according to a quote from a review in the Annals of Internal Medicine. 

In the есоnomy tоdау, mаnу аrе caught with tremendous есоnomic рrоblеmѕ and оf course, medical соѕtѕ ѕееm to be еѕресіаllу out of control. If prescription drugs соѕts are tаkіng a hugе bite out оf уоur hоuѕеhоld budget, dоn’t dо wіthоut the іmроrtаnt drugѕ уоu need. Tips and advice on ѕаvіng mоnеу on prescription costs рrоlіfеrаtе but if уоu fоllоw these tips уоu will ѕее quite a dіffеrеnсе in уоur рrеѕсrірtіоn spending.


Onlіnе Pharmacies

Many hаvе fоund thе еаѕе аnd ѕаvіngѕ that have been found uѕіng оnlіnе рhаrmасіеѕ. Mоѕt of them оffеr generic drugs at truly hіgh savings, аnd mоѕt are dереndаblе to ѕhір you уоur рrеѕсrірtіоnѕ uроn receipt оf уоur рауmеnt. Yоu wіll, of course, need to іnvеѕtіgаtе аnу online рhаrmасу уоu mау come in contact with. Your bеѕt bet is word of mouth recommendations, thuѕ if you are frіеndѕ with othеr реорlе whо either ѕhаrе уоur condition or take рrеѕсrірtіоnѕ thеmѕеlvеѕ, dоn’t bе ѕhу аnd аѕk whо thеіr рrеѕсrірtіоn рrоvіdеr іѕ. Thе аnѕwеrѕ mау lead уоu tо a fаntаѕtіс оnlіnе pharmacy that wіll ѕаvе уоu a tremendous amount of mоnеу. Уоu hаvе tо bе willing to take thе time аnd do the research.


Generic Drugѕ

Even the Fооd аnd Drug Admіnіѕtrаtіоn (FDA) tеllѕ uѕ thаt generic drugѕ hаvе thе ѕаmе active ingredients and thе ѕаmе еffесt аѕ brаnd-name drugѕ, thuѕ it makes no ѕеnѕе to adhere to brand-name drugs when a gеnеrіс drug саn bе gotten for up tо 80% less.


It іѕ оf trеmеndоuѕ importance thаt you соnѕult wіth your рhуѕісіаn rеgаrdіng роѕѕіblу ѕwіtсhіng tо a gеnеrіс drug іnѕtеаd оf thе еxреnѕіvе brand-name drug уоu аrе taking. If уоu dо your research аnd fіnd thаt there is a gеnеrіс drug that will perform just аѕ wеll for уоur соndіtіоn, аѕk роіnt-blаnk whу уоu cannot tаkе X іnѕtеаd оf Y?


Phаrmасеutісаl Cоmраnіеѕ

Shоuld уоur соndіtіоn require you to take a раrtісulаr drug that іѕ a brand-name drug and іt іѕ еxреnѕіvе, you саn оftеn ѕреаk tо thе maker оf thе drug for a Patient Aѕѕіѕtаnсе Program (PAP) whеrе аrrаngеmеntѕ mау bе mаdе fоr either free or reduced-соѕt drugs. Of соurѕе, thе hеlр muѕt bе аррlіеd for аnd bаѕеd оn your vеrіfіаblе іnсоmе the company will dесіdе іf уоu qualify fоr ѕuсh аіd. The forms for this tуре of hеlр are uѕuаllу available on thе іntеrnеt and will require your doctor’s signature as wеll.


State Hеlр

Уоur раrtісulаr state mау аlѕо offer hеlр with рrеѕсrірtіоnѕ that may be paid соmрlеtеlу fоr уоu, оr at lеаѕt offer уоu reduced-cost drugѕ. Agаіn, mоѕt оf thіѕ hеlр will be bаѕеd on verifiable іnсоmе. Mоѕt states оffеr a drug аѕѕіѕtаnсе рrоgrаm.


Partnership for Prеѕсrірtіоn Aѕѕіѕtаnсе (PPA)

The Partnership for Prеѕсrірtіоn Assistance рrоgrаm is a group оf drug companies, раtіеnt advocacy оrgаnіzаtіоnѕ, health care рrоvіdеrѕ, аnd соmmunіtу groups. ClaimLynx offers help to раtіеntѕ whо mау nоt have рrеѕсrірtіоn аvеrаgе to find аѕѕіѕtаnсе рrоgrаmѕ that fit thеіr nееdѕ. we can оffеr access to many public as wеll as рrіvаtе раtіеnt аѕѕіѕtаnсе рrоgrаmѕ. We also provide prescription savings cards that can reduce the cost of your prescriptions. 


Related Post: ClaimLinx Prescription Drug Card Services


Yоur Dосtоr

Above all do nоt fоrgеt tо іnсludе your Doctor in уоur search for lоwеrіng уоur prescription costs before either cutting down оn уоur prescriptions уоurѕеlf оr wоrѕе yet, ѕрlіt оr share mеdісаtіоnѕ. Уоur health іѕ extremely important, dо nоt jеораrdіzе it for реnnіеѕ saved whеn there is  оthеr viable hеlр аvаіlаblе.

Drug Coverage Changes With Continued Spending Hike

Spending on prescription drugs rose by 5.2 percent in 2015 and is projected to continue to climb, much faster than overall health spending, in the coming years.

The increase is largely attributed to the high cost of specialty medications used to treat conditions such as rheumatoid arthritis and cancer. And greater medication use overall due to millions of Americans gaining access to insurance coverage through the Affordable Care Act also contributed to the surge in spending.

Related Post: ClaimLinx Prescription Drug Card Services

As it stands though the rise of powerful, expensive prescription drugs has become the greatest drain on American pocketbooks. Spending on specialty medications rose 18 percent last year, while spending on standard drugs rose less than one percent, according to a report by the largest prescription benefit manager in the U.S., Express Scripts Holding Co.

The report also found the average price of brand-name drugs on the market increased by 16.2 percent in 2015 and has jumped 98.2 percent since 2011. One-third of brand-name prescription drugs had price increases exceeding 20 percent last year.

Still, this year’s increase is half the rate in 2014, which spiked to 12.6 percent, the largest price jump since 2003.

What was different in 2015 is that the overall boost in costs was moderated by more restrictions from pharmacy benefit managers and insurers. These companies exerted more control over the drugs their costumers could get access to, as they were more willing to refuse coverage of expensive medications than in the past.

Related Post: Senate digs into why drug prices are so high

This trend will likely continue as drug prices continue to rise in the coming years, forcing many customers to become more flexible with accepting generic drugs over their name-brand counterparts.

Cumulatively from 2013 to 2018, prescription drug spending is expected to rise by an average of 7.3 percent annually, according to a report from the Department of Health and Human Services.

This is down from the spike observed in 2014 but is still higher than before 2013, when the country observed unusually slow growth — spending rose about 2 percent between 2008 and 2012.

For this reason, drug spending will continue to be a growing concern for clinicians, insurers and customers alike.

ClaimLinx Prescription Drug Card Services

What many people do not know is that there are various ways to cut the cost of those expensive prescriptions that can sometimes cut into their budget. The 2 most common ways to save members money is to 1) research the particular medication the member is taking and the frequency (dosage and how many times a day/week/month the medication being used), and explore opportunities to save money, such as the use of a drug savings copay card 2) obtain additional information from the member to see if they may qualify for the manufacturer’s pharmaceutical financial assistance programs that are available (usually eligibility is based on gross household income for these programs).

Related Post: Use The ClaimLinx Prescription Savings Card

For example, if a member is prescribed Lipitor from their physician, there is a savings card called the LIPITOR Choice Card. This card is not insurance, but can be used at many participating pharmacies and can be financially beneficial to the Employer as well as the employee.  Here’s how it works:

-You will pay $4 for a 30-day supply (30 tablets) if: you use commercial/private insurance and your out-of-pocket expense for a 30-day supply of name-brand LIPITOR is $130 or less.

-You will pay $30 for a 30-day supply (30 tablets) if: you do not use prescription health coverage to purchase your name-brand LIPITOR under this program or you use commercial/private insurance and your out-of-pocket expense for a 30-day supply of name-brand LIPITOR is $130 or more.

For all eligible patients, you can qualify for up to $2500 of savings per calendar year. After a maximum of $2500, you will pay usual monthly out-of-pocket costs or the primary insurance deductible will have already been met and would then be covered under your primary insurance.

Related Post: Drug Coverage Changes With Continued Spending Hike

Another example would be the medication Humira. This is a very costly medication to both the employer and the member, and the typical price is @ $3,000.00. However, with the manufacturer coupon the cost to the member can be as little as $5.00 when they pick up their prescription at the pharmacy.

Please have the member contact Suzanne Garcia for assistance. She will need the name and dosage of the medication and a general idea of the household income.

ClaimLinx is proactively working to save our clients and members money and can provide cost-savings prescription drug programs and solutions. Contact us for more information.

Excessive Drug Costs Could Cause Price Caps

Gilead Sciences’ drug, Sovaldi, which treats hepatitis C, is currently on the market for $1,000 per pill. The high cost raises questions on whether government should regulate the cost of the life-saving drug and others of it’s kind, according to an article in Modern Healthcare.

Sovaldi has proven to be a very effective treatment, with a cure rate of more than 80%. The problem is the cost to insurers and patients: a 12-week treatment costs $84,000.

Related Post: Excessive Drug Costs Could Cause Price Caps

Karen Ignagni, president and CEO of America’s Health Insurance Plans, agrees something needs to be done.

“We need to sit together to begin talking about how we can attack this problem together before the government has to. We cannot sustain six-figure therapies and we’re at the beginning of that trend,” she said in the article.

Representatives of the pharmaceutical industry are quick to point out the high costs of developing these life-saving drugs. John Castellani, president and CEO of Pharmaceutical Research and Manufacturers of America, feels the FDA approval process needs updating.

“It costs on average $1.2 billion, and takes 10 to 12 years to get a drug to market. We have to modernize the discovery process. We can only be as innovative as our regulator,” said Castellani.

Ignagni, however, believes pharmaceutical companies should decrease pricing to avoid governmental intervention.

Related Post: Costs Spike As Pharma Companies Reprice Old Drugs

“Manufacturers are charging whatever they can get away with,” Ignagni said. “We can’t have a system that operates that way. We can’t sustain it. Talking about price is often akin to calling fire in a crowded room. No one wants to do it until they have to,” she said.

Please read the Entire Article by Paul Demko here.

ClaimLinx specializes in consulting individuals and businesses on ways to save money on prescriptions. Depending on the dose and drug, we can find a program that may reduce your costs by as much as 50%. Did you know there are many patient assistance programs that go unused every year because people don’t know about them? Employers and individuals can benefit from taking advantage of these programs saving both the company and employees thousands of dollars in medical costs.  Many programs are available online with coupons or filling out a simple form.  We can navigate you through the process to get the maximum benefit cost savings.  Contact us today if you think you are paying too much for prescriptions.