Most major health insurance providers offer several options to help cover the rising costs of prescription drugs. Health plans will often provide varying levels of coverage for prescription drugs. Due to costs of prescription drugs, patients without health insurance are likely to consider prescription drug costs and coverage a top priority when searching for new health insurance. Rand states that prescription drug spending is more than 10% of all health care spending in the US in 2021. Those currently enrolled in a health care plan can search for which medications are covered and the level of coverage on their insurance provider’s website.
Learn more about insurance coverage of prescriptions and get familiar with your health plan's formulary to ensure your needs are being met. Curative offers all preferred medications at no cost and non-preferred medications at a fixed cost. This means predictable coverage when utilizing network pharmacies.
Using Health Insurance to Navigate the Rising Cost of Drugs
As the cost to patients continues to rise for many types of medications, it is critical that health insurance providers are transparent about prescription costs and coverage.
According to the Center for Medicare and Medicaid Services in 2022, the average American spends over $1,500 on prescription drugs. This demonstrates the need for more comprehensive employer-sponsored health care. The Curative health plan, for example, offers a $0 deductible* and $0 copay for preferred medications for members, immediately taking care of the costs of many prescriptions.
Are Prescriptions Covered By Health Insurance Providers?
Every health insurance plan is uniquely different in what it offers to covered members. A list of covered drugs is often known as the formulary, which details the medications that are covered by the health plan under a certain set of circumstances.
For example, the formulary will often include medications that Pharmacy and Therapeutics committees recommend be covered. It is up to the insurance company to decide which medications will be covered and what the member cost will be. If an insurance plan member needs specific drugs that are not covered on the formulary, higher costs may be associated with it. Some drugs may not be covered and excluded from the benefit.
Prescription Drug Copays and Hidden Fees
Most health insurance plans require a copay or coinsurance for prescription drugs, even if they are listed on formulary. A copay (copayment) is a set amount that you pay for a service or product, such as a doctor visit or a medication. A deductible is the dollar amount you pay for health care services before your insurance plan starts to pay. Consumers are becoming increasingly frustrated with unanticipated and unpredictable costs when picking up their prescriptions.
Curative is taking a stand to help patients with commercial health insurance have full transparency when it comes to understanding their health care plan, offering an insurance plan that removes barriers to access and makes getting care easier than ever. With clear-cut costs, $0 deductibles, and $0 prescriptions for preferred medications* which includes brand, generic, specialty, and over the counter medications to treat almost every condition, Curative is transforming the landscape of health care when it comes to prescription drugs.
How Do Insurance Companies Decide What Medications Are Covered?
Drugs are typically covered based on safety, efficacy, affordability, and demand. This can determine whether certain types of medicines are covered and what the member cost will be. The need for a commercial health care plan that guarantees predictable and no-cost options for a range of drugs is vital.
Does the Curative Health Plan Cover Medications?
The Curative health plan offers a wide range of preferred prescription medications at no cost for members who complete a Baseline Visit within the first 120 days of plan effective date*, as well as an array of non-preferred drugs available to eligible members with predictable copays versus co-insurance. In addition, same-day delivery services are available from Curative Pharmacy in select cities for patients looking to avoid having to drive to a pharmacy. Additionally, the Curative health plan makes available a wide range of in-network pharmacies that can support delivery services, maximizing convenience for every member.
Our 2023 Curative Drug Formulary is an easy to access resource for Curative Health Plan members looking to find out if their prescribed medication is covered and if it is on the preferred $0 list. The formulary is broken down into preferred and non-preferred medications that can help patients easily identify and calculate their out of pocket drug costs. All tiers may contain over-the-counter, generic, brand, and specialty drugs.
Preferred Drugs (Tier 1)
The first level of the Curative formulary, Preferred Drugs, includes an exhaustive list of generic, brand, and over the counter medications that are completely covered by the Curative Health Plan*. These drugs come with a $0 copay for members using in-network pharmacies. Preferred drugs are selected by the Pharmacy and Therapeutics (P&T) committee and are deemed safe and effective. Our formulary offers preferred drugs to treat most diseases.
Non-Preferred Drugs (Tier 2 and 3)
Non-Preferred Drugs fall within Tier 2 and Tier 3 of Curative’s formulary. These drugs may also be effective, but the P&T committee has found other formulary options to be more beneficial. Drugs within Tier 2 of the formulary come with a $50 copay, and drugs within Tier 3 of the formulary come with a $250 copay.
Employers, providers, Curative health plan members, and non-members alike are encouraged to familiarize themselves with the formulary to ensure that their medication is covered. If a specific medication is not listed, Curative can work with you and your provider to find you an alterative that is covered or complete a prior authorization, if needed. Members can contact their pharmacy or health plan to see what alternative medications are available.
Optimize the Best Pharmacy Benefits in Texas and Beyond with the Curative Health Plan
Part of the Curative mission is to offer transformative health care experiences to the Texas community through a comprehensive plan that has transparent pricing, 24/7 access to care, and patient-centered services. In-network members who complete their Baseline Visit within 120 days of plan effective date can explore some of the unique benefits made available to them, such as access to the soon-to-be-opened Curative Commons in Austin and virtual visit urgent care through our partnership with NormanMD**.
Our comprehensive 2023 Curative Drug Formulary offers coverage for numerous medications without $0 copay, with many other medications available at a significantly discounted cost with a predictable copay. As soon as same day and next day free delivery services are also available from Curative Pharmacy in select cities. Curative Pharmacy currently services Texas and Florida, with several states including California, Washington, Maryland, Virginia, and DC coming soon! See what else is covered and optimize the individual health care experience when you ask us about the Curative health plan today.
*Curative members are eligible for $0 copays and $0 deductibles if they complete a Baseline Visit within 120 days of plan effective date.
**Health care provided through the NormanMD network of medical providers. Treatment options and eligibility determinations made by independent licensed medical providers.
**Patients experiencing a medical emergency or who have concerns about their medical situation should call 911 (or the local emergency number) immediately.
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