Start with the formulary
A formulary is the plan’s list of covered drugs. Check the exact medication, strength, and form. Drug tiers can have different cost sharing, and a covered medication can still have conditions to meet.
Look at the pharmacy and annual costs
Preferred and standard network pharmacies can have different costs. Compare premiums, applicable deductibles, and estimated spending across the year. A low premium does not tell you what your prescriptions will cost.
Understand coverage requirements
- Prior authorization: the plan may need approval before coverage
- Step therapy: the plan may require another covered medication first
- Quantity limits: the plan may restrict how much is covered within a period
- Exceptions and appeals: ask the plan about its process when coverage does not fit
Review changes each year
Formularies, pharmacy participation, costs, and coverage rules can change. Read your plan notices and verify current information. Coverage today is not a promise of indefinite coverage.
Bring a complete list to your appointment
Include medication name, strength, form, frequency, and preferred pharmacy. Do not enter medication details or health history in the initial website request. We will discuss how to share them during your review.
Educational content reviewed September 7, 2026. Confirm current rules and specific plan details before enrolling.