How to check your medications.

Step-by-Step Directions: How to Look Up Medications on Individual Family Plan Market Health Plans

Accessing Formulary Information Directly from Carrier Plans Using the SBC

Introduction

When selecting an individual or family health insurance plan directly from a carrier, it’s important to ensure that your medications are covered. Each plan has a Summary of Benefits and Coverage (SBC) document and a formulary—a list of covered prescription drugs. The following step-by-step guide will help you navigate from the SBC to the plan’s formulary, so you can look up your medications efficiently.

Step 1: Obtain the SBC for the Specific Health Plan

The SBC (Summary of Benefits and Coverage) outlines the coverage details for each health plan. You can usually find the SBC:

• On the SureCo’s Platform under the highlighted benefits and drug coverage information, select “Benefit Summary.”

Step 2: Locate the Formulary Link Within the SBC

The SBC typically includes a section on prescription drug coverage. Look for wording such as “Prescription Drug Coverage,” “Formulary,” or “Covered Medications.” There should be a hyperlink or a web address that directs you to the plan’s formulary on the left-hand side of the drug copayment information.

• If viewing a digital SBC, click the hyperlink to access the formulary.
• If reviewing a PDF or printed SBC, note the web address and enter it into your web browser.

Step 3: Access the Carrier’s Formulary Page

After following the link or entering the web address from the SBC, you will arrive at the carrier’s formulary page. This page may require you to select your specific plan or enter identifying information (such as the plan name or ID). You can also review as a Guest.

Note - although you are receiving a contribution from your employer to purchase a plan, you would not select "Employer Sponsored Plan" when locating the proper formulary. You would choose "Individual Family Plan" or "I purchase coverage myself."

Step 4: Search for Your Medication

1. Locate the search tool or alphabetical list on the formulary page.
2. Enter the name of your medication in the search box or browse the list to find it.
3. Make sure to select the medication name with the same dosage that you are currently prescribed.
4. Review the coverage tier, restrictions, and any notes regarding your medication (such as prior authorization or quantity limits).

Step 5: Confirm Coverage and Next Steps

• If your medication is listed and covered, note the coverage tier (generic, preferred brand, non-preferred, specialty, etc.). Reference the Summary Benefit Coverage to see the copayment price.
• If your medication is not listed or listed as NF or Non-Formulary the medication you are looking up is not covered on that plan and you would pay for the full cost out of pocket.
• Review any requirements such as prior authorization, step therapy, or quantity limits.

Tips for Success

• Always check the formulary for the specific plan and coverage year, as formularies can differ between plans and update annually.
• Save a copy of the formulary for your records or screenshot your results.
• If you have multiple medications, repeat the search for each one.
• If you encounter any issues, reach out to the carrier’s pharmacy department or customer service for assistance.

Conclusion

By following these steps, you can efficiently verify whether your medications are covered under a specific individual family plan directly with a carrier. Always review the latest formulary and communicate with the carrier for any questions regarding drug coverage.