Eligible Prescription Drugs

Oftentimes our brokers get inquiries about prescription drug coverage, in particular what types of drugs are covered and what are not. 

First it needs to be understood that this will vary, depending on the type of individual health insurance plan you have. However, having said this there is prescription drug coverage that is common to most plans.

To be covered by your health plan the prescription must first be prescribed by a licensed physician, and also have what is called a "DIN" (drug identification number) number that identifies the drug. Note that one DIN # can be used for products with different sizes (as long as all other product characteristics such as the product name, manufacturer name, etc. are the same).

Some examples of commonly covered prescriptions are: lipitor, prozac, amoxil, insulin, etc. .

The following are common exclusions to covered prescriptions:

• Fertility drugs are generally excluded (an exception to this is the FlexCare ComboPlus Enhanced plan).
• Some life style drugs and experimental drugs that have not been approved by the Medical Association are excluded.
• Over the counter drugs are not eligible medications.

Also, reimbursement of drugs is based on the lowest-cost generic equivalent ( if available) for many health plans.

If you do not know if a medication is covered by your health plan then call your insurance company, and give them your policy number and the DIN # of the particular prescription drug you were prescribed.

If you do not know the DIN number of a prescription drug click on the following link, select "DIN" and then enter the name of the drug in question: - Get DIN # -.