This video discusses how health insurance typically covers expensive specialty medications, despite pre-existing conditions. Here are some key points:
- Formulary and Tiering: Insurance plans categorize medications into tiers in their formulary, with specialty drugs often in higher, more expensive tiers.
- Prior Authorization: Some plans require doctor’s confirmation of medical necessity before covering certain medications.
- Step Therapy: Insurers may require trying less expensive medications before approving coverage for costlier specialty drugs.
- Out-of-Pocket Costs: Patients are typically responsible for co-payments, coinsurance, and deductibles, even when a medication is covered.
- Manufacturer Assistance: Patients are encouraged to contact drug manufacturers for possible free or discounted medications.
