How do I find out if a certain perscription is covered in my insurance plan?

Question

I have decided after 10 years to quit smoking....

I am going to the Dr. Monday to get a prescription for a drug that has worked wonders on 5 people I know to help them quit. I have bluecross bluesheild ppo and I was wondering if this drug will be covered under my plan. How do I go about finding out?

Answer 1

Chantix (varenicline tartrate,) is usually covered on Blue Cross plans. Each Blue Cross is separately owned/operated in each state, so a definitive answer is tough. I suggest going online and looking up the Blue Cross in your state. The website will have a list of medications covered.
It is also possible that one on one smoking cessation meetings with a counselor are covered with a low co-pay per appointment. This one-two punch, (medication and counseling,) will be the most effective.
If, on the odd chance Chantix is not covered, (which I highly doubt, but most likely has a high co-pay,) keep in mind that you may petition Blue Cross to cover it.
Ask for free samples when you see the doctor, and good luck.

Answer 2

Call member services and ask. If it's not covered, ask about alternatives that are covered. (Many will relent and cover a non-covered drug if you can document treatment failure with covered medications.)

This is not a guarantee either way. Insurance companies ALWAYS give a disclaimer of "Quote of benefits is not a guarantee of payment. Actual benefits are determined when a claim is received." Meaning, they can tell you whatever you want to hear, but DO something totally different when they get the bill. (It happens more than you think!!) So, you might want to discuss alternatives with you doctor while you're there - just as a backup plan. Meaning, if your plan doesn't pay for or this drug isn't on their preferred list, and the pharmacy wants an arm and a leg, what would the doctor suggest as something else to try? Many pharmacies - especially the mom & pop ones - will call the doctor to ask about a change in prescription for REALLY expensive ones.

Good luck! And speaking as an ex-smoker, the first two weeks s*ck the most - if you can get thru it without biting anyone, it should be downhill from there!

Answer 3

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Answer 4

Check the prescription coverage on your health plan. Most plans have something called a formulary list - a list of covered drugs. Often it has several tiers within it. Many insurers have them available on-line. If not, call your insurer's customer service function and ask.

Answer 5

i had this same problem a month ago you will need to call your doctor and ask about how the drug is identified for the insurance company ( it has a code name) then on your insurance card call the patient/customer numer and give them the code. within 10 minutes they can tell you if they cover it.

good luck! I hope its covered and i hope it works for you!

Answer 6

Contact your Health Insurance Provider. The # should be on your Insurance card.

Answer 7

I would just call the customer service line. They will be able to tell you.