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How a New Medication Can Affect Your Health Plan

Changes to Your Medications?

Each year, the experts at RetireMed help you find the plan that best meets your needs, including important prescription coverage. But what happens if your health changes throughout the year and you need a new medication or a different dose of a current one? Adding new prescriptions to your health care routine can affect your health plan. Here are a few items to consider before filling a new medication at your pharmacy.

Important Things to Consider When You Start a New Prescription

  • Your doctor wants you to be on the right medications for your health and wellness.
  • It’s unlikely your doctor is checking to make sure those medications will be covered by your plan.
  • All health plans with drug coverage have a formulary, which is a list of medications that are covered by your plan.
  • Just because your doctor writes you a prescription does not guarantee that your medication will be covered. You must check your plan’s formulary first to find out if it’s on the list.
  • If you fill a prescription that is not covered by your plan, you may be responsible for paying the full cost of the medication.

How to Check if Your New Prescription Will Be Covered

There are two ways to check if a medication will be covered by your plan.

  1. Check your plan’s formulary. This booklet is available on your plan’s website or as a hard copy, which the insurance company can mail to you.
  2. Call us! We have access to your plan’s formulary as well as other plan information. We can look up medications while we’re on the phone with you and let you know if and how they will be covered.

What to Do if Your New Prescription is Not Covered

  • Ultimately, your doctor knows best which prescriptions will be best for you, so you should always take his or her advice. But you can always ask your doctor about alternative medications that will work for you. If another option is available, we can help you determine if that medication will be covered on your plan’s formulary.
  • If there are no drug alternatives, your doctor may apply for a formulary exception with the insurance company. If approved, your medication will be covered.
  • If you cannot get an exception, check with your pharmacy to see if there are any coupons or discounts available.
  • Finally, if a medication is not covered by your plan but fits your personal health care budget, you can choose to pay for it out of pocket.


Please do not hesitate to contact our Client Services team if you have any questions! We are available at 877.222.1942 or

If you are not a RetireMed client yet and have questions about how we can help you, please contact us at 937.915.3563 or to get started on your Medicare journey.



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