When selecting health insurance coverage to suit your and your family’s needs, you may think it is safe to assume your plan will help cover the medicines prescribed by your doctor. This, however, is not always the case. Beyond making sure the treatment you need is listed on an insurance company’s list of covered medicines, or formularyThe list of prescription medicines covered by a health insurance plan. A non-covered medicine is not included in the list of prescription drugs covered by an insurer. For non-covered medicines, patients must pay for the cost of the medicine or go through an exceptions process to get it covered. Also see Drug List or Tiers., there may be additional steps that insurers require before you can get the medicine you were prescribed.

Important terms to know are step therapyHealth insurers may require patients to try certain medicines before allowing a patient to get the medicine his or her doctor originally prescribed. This is sometimes called fail first. Also see Preauthorization, Prior Authorization and Fail First. (aka “ fail firstHealth insurers or plans may require patients to try certain medicines before allowing a patient to get the medicine his or her doctor originally prescribed. This is sometimes called step therapy. Also see Prior Authorization and Step Therapy.”) and prior authorization. These are processes your insurer may require you to complete before covering the medicine your doctor prescribes. In instances where you and your doctor have already determined that a different medicine isn’t right for you, this can be an added burden. And even after your insurer agrees to cover a medicine, you may be responsible for additional out-of-pocket costs.

This is an example of one of the challenges you may face when trying to access the medicines you need.