Does Insurance Cover Specialty Medications?

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This video discusses how health insurance typically covers expensive specialty medications, despite pre-existing conditions. Here are some key points:

  1. Formulary and Tiering: Insurance plans categorize medications into tiers in their formulary, with specialty drugs often in higher, more expensive tiers.

  2. Prior Authorization: Some plans require doctor's confirmation of medical necessity before covering certain medications.

  3. Step Therapy: Insurers may require trying less expensive medications before approving coverage for costlier specialty drugs.

  4. Out-of-Pocket Costs: Patients are typically responsible for co-payments, coinsurance, and deductibles, even when a medication is covered.

  5. Manufacturer Assistance: Patients are encouraged to contact drug manufacturers for possible free or discounted medications.