Have you ever gone to the pharmacy to pick up your monthly meds and discovered how expensive the bill was? There’s a range of health insurance plans available, but some Americans may be shocked to find out certain drugs aren’t covered. Today, we’re going to explore this issue and unearth the real reasons why certain drugs are not covered.

Health Plans

Under the Affordable Care Act, all health plans sold on the marketplace must provide prescription drug coverage. The same rule also applies to all policies sold through the individual market or to small businesses with less than 50 employees.

Large corporations are not required to cover prescription medications by law, yet most of them do anyway. If you’re unsure, check with your manager with human resources to go over the details of your policy.


Insurance companies don’t cover all prescription drugs because it’s simply to expensive. It’s important to remember that they operate like a regular business, and are continually looking for ways to reduce overall costs. It’s standard practice for each company to negotiate with drug manufacturers to get a rebate or reimbursement.

For example, it’s kosher for Blue Cross to strike a deal with Pfizer (the drug manufacturer) for coverage regarding Celexa, a common antidepressant. Meanwhile, Aetna can also negotiate with Pfizer and strike a deal to ensure their clients get the generic version of Celexa, which is known as citalopram.

While both patients will virtually be receiving the same medication from the same manufacturer, their coverage differs based on these relationships between insurers and producers. The best way to prevent any surprises at the pharmacy checkout line is to read up on insurance policies’ list of covered drugs. Most companies will typically include the generic unless specified by your doctor.

The Reality Of Insurance

The concept of insurance has been around for a few hundred years and was created to safeguard against the unexpected. This basic idea applies to all domains of insurance, whether house, mortgage, automobile or health. It’s meant to cover exorbitant costs that are beyond the normal threshold, and it was never designed to cover absolutely everything under the sun.

Therefore, if you’re on a Silver Obamacare plan, don’t expect for your insurance company to cover a cosmetic laser treatment to remove an unsightly acne scar.

How Can You Avoid Paying More?

According to a survey conducted by eHealth, more than a third of respondents stated they “had to pay more than expected for prescription drugs” in 2016. The same report says that Americans spend over $800 annually on out-of-pocket costs associated with non-covered prescription drugs.

So how can you avoid paying out-of-pocket? As we’ve previously mentioned, do your homework and adequately research your plan, especially if you’re shopping around the marketplace during the Open Enrollment Period. If you’re working with an insurance broker, make sure to ask questions and understand what you’re getting into before signing up.

If you have any questions regarding this subject, you can always contact one of our agents here at HealthQuoteInfo. Feel free to give us a call at 1-855-881-0430!