Q & A: How Do I Know if my Medication Is Covered by my Health Plan?

Whether it’s a daily high-blood pressure medication or a quick dose of antibiotics to cure a child’s sinus infection, having access to medication when you need it plays a large role in keeping Michigan families healthy. That’s why it’s so crucial that you have the right kind of health care and prescription drug coverage to meet all of your and your family’s needs.

Although prescription coverage may not be the only factor in deciding your health plan, ensuring certain necessary medications are covered ahead of time can help you avoid surprising out-of-pocket costs. But how can you tell what’s covered? Use one of the following resources:

Visit Your Account Online
Log into bcbsm.com to see a full list of medications covered under your plan. To check on a particular drug, click on “My Coverage” at the top of the page, select “Prescription Drugs,” then “Price a Drug.” You’ll need to know the name of the drug, the dosage and how often you’ll be taking it. If the medication is not covered under your plan or requires coverage review prior to approval, you’ll receive an alert.

Reference the Drug List
A drug list, also known as a formulary, is a list of medications approved by the U.S. Food and Drug Administration that are also covered by Blue Cross Blue Shield of Michigan and Blue Care Network. The type of health plan you have determines your drug list. For example, all of Blue Cross’ 2016 individual and family plans use our Custom Select Drug List.

You’ll notice that the medications on the Blue Cross drug lists are grouped into tiers. That’s to make it easier to locate the exact drug you’re looking for and immediately understand the cost. The lower the tier, typically the less expensive the medication. All generics covered by Blue Cross plans are in Tier 1, since they come with the lowest possible copay. Check out our drug list for your plan to find out if your medication is covered and its tier.

If the medication you’ve been prescribed isn’t covered or is in a higher-cost tier than you’d like, speak to your doctor to see if there are generics or alternatives available.

Have other medication questions? Visit one of these posts for more tips:

Photo credit: Army Medicine

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