Many people’s daily healthcare routines revolve around prescription drugs. So understanding how your health insurance covers these costs is crucial to keeping your overall healthcare costs under control. Priority Health keeps prices as low as possible by offering comprehensive prescription drug coverage, making it easier for members to get the medications they need. In this article, we’ll discuss how Priority Health covers prescription drugs, how to learn more about your benefits, how to get your medications, and how to save money on prescription drugs.
1. Understand Priority Prescription Drug Coverage
Priority Health offers prescription drug coverage as part of its health insurance plan, which covers both generic and brand-name drugs. The type of plan you have (HMO, PPO, other policies) can affect the terms of your prescription drug coverage. Typically, your insurance company will cover a range of prescriptions listed on the form (approved drug list) at multiple levels of coverage. Drugs on the form are more comprehensively covered; People who are not on the list may need additional authorizations or higher out-of-pocket costs.
Familiarizing yourself with the formularies and the different tiers of drug costs can help you maximize your prescription coverage. Priority Health formularies are typically set up in tiers, consisting of Tier 1 (the least expensive drugs, usually generics), followed by drugs in Tier 3 or higher, which are usually more expensive brand-name drugs.
2. How do I get prescription drugs through Priority Health?
Once you know how your plan handles prescription drugs, the next step is to get the medications. Priority Health offers several ways to get your medications, including local pharmacies, mail-order pharmacies, and telemedicine services.
Typically, people can fill their prescriptions at a local participating pharmacy within the Priority Health network. Priority Health partners with several large drugstore chains and community stores to make your prescriptions easy to fill. Typically, you will pay a lower co-pay if you visit an in-network pharmacy than if you visit a non-network pharmacy.
Using Priority Health’s mail-order pharmacy services is another option open to members. Those who take medications regularly and want to have their prescriptions conveniently delivered to their homes can benefit greatly from a mail-order pharmacy. Additionally, some medications can be more reasonably priced when purchased through a mail-order company, as buying in bulk helps reduce the overall cost.
3. Coverage Details and Pharmacy Network
Checking to see if your pharmacy is part of the Priority Health network can help ensure that your medications are covered at the best price. Priority Health has a large network of local, independent pharmacies and pharmacies from large chain partners. Before filling a prescription, check the Priority Health website or mobile app to see if your pharmacy is a network member.
Agreements between in-network pharmacies and Priority Health allow them to provide medications at prices specified by your insurance plan. If you go to an out-of-network pharmacy, your prescription may not be fully covered and you may have to pay more. To make sure you get the most affordable option for your plan, ask your pharmacist.
4. The Role of Forms in Prescription Drug Coverage
Priority Health’s prescription drug coverage is one of its most important features. A form (a list of medications covered by your insurance plan) can help you estimate the cost of each medication. Drugs on the form come in multiple tiers, each representing a different cost level. Brand-name drugs are in the higher tiers; generics are usually in the lowest tier.
It’s crucial to find out if what your doctor prescribed is on the form and what tier it falls into. Drugs in higher tiers may have coinsurance or co-pays. If the drug isn’t on the form at all, it may not be covered by your plan unless your doctor asks for an exception.
5. Tips to Save Money on Prescription Drugs
Although prescription drugs are expensive, there are ways to help reduce the out-of-pocket costs that come with them. When generics become available, they are one of the best ways to save money. Although generics are usually much cheaper, they are chemically identical to brand-name drugs. Priority Health encourages members to consider generics, which are often found in cheaper categories on the prescription.
Using mail-order pharmacies—which can be cheaper, especially for regularly taken medications—is another cost-saving strategy. If you have a chronic illness and need medications long-term, mail-order services can also ensure that you never run out of them.
6. Prior Authorization for Specific Drugs
Sometimes, certain medications require prior authorization before they are covered by your plan. Therefore, your healthcare provider must submit additional information to Priority Health to support the need for the specific medication. High-cost medications or medications that are rarely used to treat an illness often require prior authorization.
If you are prescribed a medication that requires prior authorization, make sure your doctor submits the required documentation to avoid coverage issues or delays. Once you accept the authorization, the medication will be covered by your insurance plan. If the authorization is denied, your doctor can help you find another covered medication.
Conclusion
Maintaining your health and managing chronic diseases depends on prescription medications. That’s why Priority Health offers several ways to ensure you get the medications you need at affordable prices. You can maximize your prescription drug coverage by understanding your plan’s formulary, selecting in-network pharmacies, researching cost-saving ideas, and obtaining prior authorization when necessary. Managing your medications has never been easier with Priority Health’s tools and customer service.
FAQs
1. What medications does Prior Health cover?
Priority Health focuses on solving the problems of generics, brand-name drugs, and specialty drugs, as well as other prescription drugs. The plan and the formulary, including approved medications, determine coverage.
2. Describe a formulary and explain how it affects the price of my prescriptions.
A formulary is a hierarchical list of medications that are covered by an insurance company. While higher-tier or over-the-counter medications may cost more or require prior authorization, lower-tier medications (usually generics) have smaller out-of-pocket costs.
3. Find out if my prescription is covered.
To find out if your prescription is covered and at what level, visit their website or mobile app or call their customer support.
4. Can I pick up my prescription at any pharmacy?
In-network pharmacies help you maximize your benefits and reduce out-of-pocket costs. Find Priority Health’s established network of partner pharmacies using their directory.
5. Does Priority Health offer mail-order medications?
Priority Health offers convenience and potential cost savings through mail-order pharmacy services. This alternative can be especially helpful for long-term or maintenance medications.
