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Guide provided by http://www.dmhc.ca.gov/  Link here

Prescription RX Drugs and California medical insurance plans

If your California medical plan covers prescription drugs, your doctor will usually choose medicines from a list of the drugs the plan covers. This list is called a formulary. Many drugs on the formulary are generic drugs. Generic drugs usually cost less than brand-name drugs, but they have the same basic ingredients.

Prescription RX Drug Costs in California

Usually, you will pay a fee, called a co-pay, each time you pick up a prescription. Some drugs may have higher co-pays than other drugs. There may also be a limit on the amount your plan will pay for drugs each year. Ask your medical plan if you can order prescriptions by mail. They almost always cost less, and you can usually get a 3-month supply at a time.

If You Have Medicare

Medicare has a new prescription drug program, called Medicare Part D. For more information, visit CalMedicare or call your Medicare Advantage plan.

If You Cannot Get the Medicine You Want

If you need a drug that is not on your medical plan's formulary, you must get your plan's approval or pay for the drug yourself. Your doctor should ask the plan for approval. In certain cases, a California medical plan may be required to cover a drug that is not on your plan's formulary. If your plan does not approve a drug that your doctor has prescribed, you can file a complaint with your plan.

Some California medical plans require step therapy. This means that you have to try a drug that is on the formulary before you can get a drug that is not on the formulary.

Useful Tips for Taking Medicine

  • Ask about the side effects, risks, and benefits of medicines.
  • Tell your doctor about any allergies or bad reactions you have had to any medicines.
  • Tell your doctor all the prescription drugs, over-the-counter medicines, and supplements you take.
  • Tell your doctor if a drug does not seem to be helping.
  • Talk to your pharmacist about when to take the drugs and what the side effects may be.
  • Ask to see the list of drugs your medical plan covers. This list is called the formulary.
  • If a plan covers prescription drugs, it must cover prescription birth control methods.
  • Medical plans must cover diabetes supplies.

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