The Affordable Care Act set out to reshape and improve the American health care system. A major part of this bill was to standardize the type of coverage available so that all health insurance plans would offer the same minimum benefits. One of these new requirements is that all insurance plans must offer some prescription drug coverage.
New Prescription Drug Coverage Requirements
Before the Affordable Care Act passed, health insurance plans did not need to cover prescription drugs. This proved to be a significant coverage gap. If you signed your company up for a plan without prescription drug coverage, you and your employees would have had to buy a separate plan to cover these expenses or pay out of pocket for prescriptions.
Now, as Forbes states, the Affordable Care Act requires that all health insurance plans offer 10 essential benefits, including maternity care and lab tests. Prescription drugs are also one of these essential benefits, so any plan that you buy for your company will need to offer this coverage.
Types of Prescription Drugs Offered
The Affordable Care Act also sets requirements for the types of prescription drugs that must be offered in a health insurance plan. Every medical plan needs to offer at least one drug from every category and class listed in the United States Pharmacopeia, the list of all approved medications in the U.S., according to the Federal Register. Health insurance plans don’t have to cover every drug out there, though, so you or an employee could run into a situation where a needed prescription isn’t covered. In this case, a patient and their doctor can make a request to have the drug covered, provided that it is medically necessary. Or, the doctor may be able to prescribe a comparable drug.
Cost of Plans
The cost of your prescription drug coverage will vary depending on the type of health insurance plan you select for your company. Within its new requirements, the Affordable Care Act gives insurers room to set up different types of plans to create a more balanced market.
Plans that are less expensive per month will have higher co-payments and deductibles for prescription drugs and will most likely have smaller formularies, the list of covered prescription drugs. More expensive plans will have lower out-of-pocket costs and would give your employees access to a larger list of prescription drugs. You should consider this trade-off between cost and coverage before signing up for a plan.
One impact of the Affordable Care Act’s new requirements is that comparing different plans should get a bit easier, because at least you’ll know that every plan will offer at least some minimum level of prescription drug coverage.
This content is provided solely for informational purposes. It is not intended as and does not constitute legal advice. The information contained herein should not be relied upon or used as a substitute for consultation with legal, accounting, tax and/or other professional advisers.
David Rodeck is a professional freelance writer based out of Delaware. Before writing full-time, he worked as a health- and life-insurance agent. He specializes in making insurance, investing and financial planning understandable.