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It’s always something. Just when it seems like you’ve got a handle on the medications you need to purchase for your senior family member, something changes. A new drug becomes available an old one goes off the market. Or a new national health plan promises to change everything, throwing all your expectations and certainties up in the air, leaving you wondering what the future will bring. Though the Affordable Care Act (ACA) is being touted as a big step forward, reducing healthcare costs for all Americans. The changes it will bring can be overwhelming. Here is some reassurance that when it comes to prescription drug coverage, relatively little will change.

The most important thing to keep in mind is that all health plans available in your state will include prescription drug coverage. The Affordable Care Act outlines ten essential provisions every health care plan must include, and prescription drug coverage is on the list. That’s a big sigh of relief for the millions of Americans who take multiple medications every day.


With that being said, prescription drug coverage plans will vary from state to state, so it’s important to be prepared when you?re researching and choosing the best health insurance plan for your loved one. For each health plan offered by your state, covered medications will be listed in a formulary, which will list brand and generic names as well as dosages of medications. Before accessing the formulary for any health plan you may be considering, obtain the exact name of the medicine, the usual dose that is taken and how much the doctor typically prescribes. Then access the formulary (some formularies may be listed on a health plan?s website) and see if your family member?s medications are covered. If the medications aren?t covered, you can petition that they be added to the formulary.

Most of the new health care plans have a set copayment for each medication in the formulary, but these are fairly easy to understand:

  • Tier 1: Generic medicines, which cost the least
  • Tier 2: Preferred, brand-name medicines
  • Tier 3: Non-preferred, brand-name medicines
  • Tier 4: Specialty medicines, which are often costly, brand-name medicines such as chemotherapy drugs.

Bear in mind that the ACA is designed to reduce healthcare costs for all Americans, especially senior citizens. After a bit of hassle doing paperwork and ensuring that all your family member’s drugs are covered, the process of ordering, paying for and procuring the needed medications should be far more streamlined.

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