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

If your state uses HealthCare.gov, a prescription look-up tool is available when shopping for a plan that will tell you whether your health plan covers a prescription drug on its “formulary” (a list of covered drugs) and other information, such as the cost sharing structure. A similar feature may be available if your state operates its own Marketplace website. Click here to look up the Marketplace in your state.

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 submit an appeal to the insurer for an exception to the plan formulary. Generally, if the exception is granted, your health plan will cover the drug, but you can be charged the cost-sharing amount associated with the highest (most expensive) tier of your drug plan. If your insurer denies your exception request, you have the right to appeal the decision. You can learn more about the appeals process for denied coverage here.