This section shares information on prescription drugs and medications. You may be eligible for help paying for prescription drugs whether you have insurance or not. You can learn about:

• state pharmacy programs to apply for
• buying prescription drugs
• step therapy, and
• getting medications through Medicare Part D.

Below we also describe common problems with insurance coverage and prescription drugs.

What If My Insurance Won’t Pay for My Prescription?

If your insurance won’t cover a prescription and you are at the pharmacy, take these steps:

1. Ask the pharmacist why payment for the prescription was denied. Sometimes they can see this in the computer, but sometimes they can’t.
2. Call your insurance company. Usually the number is on the back of your insurance ID card. Many problems can be fixed by calling your insurance company.
3. Ask the pharmacist how much the prescription costs without insurance. You can also ask if there are any discounts available to you. 

Common problems and what you can do:

• No insurance. Double check that your insurance is active by calling your insurance company. If you don’t have active coverage, ask what you need to do to get back onto insurance and how long this will take. Tell them if this is urgent and you need the medication now.
   
• Medication is not covered by your insurance plan. Some medications are not covered on some insurance plans. Ask your doctor if there is another medication that will work for you.

• Medication needs a prior authorization (PA). Some medications require prior authorization (PA) from the insurance company. PAs must be approved before picking up the medicine in order for the insurance company to cover it. If this is the problem, you can:
  • Call your insurance company and ask how to get a prior authorization.
  • Call the doctor that prescribed the medication and tell them you need a PA.
  • Appeal the decision if your doctor already submitted a PA and your insurance denied it. Call the Office of the Health Care Advocate at 1-800-917-7787 for help with the appeal.  

• Step therapy. Sometimes you can’t get a particular medication until you’ve tried a less expensive medication and found that it doesn’t help you. Your insurance company should tell you if this is the problem. If you have tried the less expensive medication before and it didn’t help you, ask your doctor to document this for the insurance company. Read more about step therapy.
   

There are other reasons why prescriptions may be denied at the pharmacy. 

If you need help getting your medication, call the Office of the Health Care Advocate at 1-800-917-7787. If you reach our voicemail, please leave a message with your name, phone number and the problem. In your message, please say if the problem is urgent and when you will run out of the medication.

You can also request help by filling out our Help Request Form.