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:
Formulary and Tiering: Insurance plans categorize medications into tiers in their formulary, with specialty drugs often in higher, more expensive tiers.
Prior Authorization: Some plans require doctor's confirmation of medical necessity before covering certain medications.
Step Therapy: Insurers may require trying less expensive medications before approving coverage for costlier specialty drugs.
Out-of-Pocket Costs: Patients are typically responsible for co-payments, coinsurance, and deductibles, even when a medication is covered.
Manufacturer Assistance: Patients are encouraged to contact drug manufacturers for possible free or discounted medications.
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