Prescription Coverage: What It Is, How It Works, and How to Get Help

When you hear prescription coverage, the portion of your medication costs paid by insurance or government programs. Also known as drug coverage, it’s what keeps millions of Americans from choosing between their pills and their rent. But coverage isn’t the same for everyone. Some plans cover brand-name drugs only. Others force you to try cheaper generics first. And if you’re on Medicare, you might not even realize you’re eligible for Medicare Extra Help, a federal program that cuts monthly premiums and copays for low-income seniors. This isn’t just paperwork—it’s about whether you can afford to stay alive.

Many people think if they have insurance, they’re covered. But that’s not true. SPAP programs, State Pharmaceutical Assistance Programs that help people who earn too much for Medicaid but too little to pay full price exist in 40 states—and most don’t know they’re eligible. These programs cover drugs Medicare doesn’t, like certain cancer meds or rare disease treatments. Then there’s the gap between brand and generic drugs, medications with the same active ingredients as brand names but often 80% cheaper. Insurance companies push generics because they save money—but patients often don’t know they’re just as safe. A 2023 FDA study found 95% of generics work exactly like their brand-name versions. Yet, some doctors still default to the pricier option.

And when coverage gets denied? That’s when things get messy. You might get hit with a prior authorization hold, a step therapy requirement, or a formulary exclusion. That’s why so many people skip doses, split pills, or go without. But you don’t have to. There are appeals, patient assistance programs, and nonprofit groups that help you fight back. The posts below show you exactly how to navigate this system: how to check your plan’s formulary, how to apply for state aid, how to spot an authorized generic on the pharmacy shelf, and how to talk to your doctor when your insurance won’t cover your meds. You’ll find real stories from people who got their prescriptions covered after being told no. You’ll learn how to read a drug list, what to say when you call your insurer, and which programs actually pay out—not just promise to.

Employer Health Plans and Generic Preferences: How Formularies Control Your Drug Costs

Employer health plans use tiered formularies to push generic drugs and cut costs-but the savings don't always reach you. Learn how formularies work, why drugs get dropped, and what you can do to protect your coverage.