Will My Colorado Medications Be Covered?

By carefully reviewing and comparing the formularies and plan details, you can select a health insurance policy that adequately covers your Colorado health insurance medications.

A young professional who we had met networking and subsequently provided our services to, had recently been diagnosed with an autoimmune condition and he needed to change health insurance due to a job relocation. He was anxious about whether his new plan would cover the specialty drugs that kept his condition under control. I worked closely with him to identify insurance options that included his specialty medications in their formularies. By comparing various plans, we found one that not only provided comprehensive coverage for his medications but also offered a mail-order option that further reduced his costs. Our networking partner and client successfully switched plans without any interruption to his medication regimen, allowing him to focus on his new job with confidence.

Colorado Health Insurance Medications Overview:

• Know before you buy
• Payment Tiers
• Cost Control
• Cost-Effective Choices
• Formulary Management
• Patient Cost-Sharing
• Pharmaceutical Negotiation

Know before you buy:

To ensure your Colorado health insurance medications are covered under a state exchange health insurance policy, follow these steps:

1. Email Ian Young Health Insurance today or schedule an appointment for assistance.
2. Create a List of Medications.
3. Front-load your meds into the CO Marketplace’s Quick Cost & Plan Finder.
4. Check the Formulary on each health insurance company’s website.
5. Understand & Review Tiers and Restrictions: this impacts costs and restrictions like prior authorization or quantity limits.
6. Contact Customer Service – call the insurance company’s customer service for assistance.
7. Compare Plans and see which one best covers your medications at a reasonable cost.
8. Consult Your Doctor.
9. Consider the Total Cost.
10. Review Annually.

Colorado health insurance medications Payment Tiers:

State exchange medications are often placed on payment tiers to control costs and encourage the use of lower-cost medications whenever possible.

Here are a few reasons why this happens:

Cost Control:

Insurers and state exchanges often negotiate with pharmaceutical companies to secure lower prices for medications. Payment tiers help allocate costs based on these negotiated prices, with lower-tier Colorado health insurance medications costing less out-of-pocket for patients.

Encouraging Cost-Effective Choices:

By placing Colorado health insurance medications on different tiers, insurers and state exchanges aim to encourage patients and healthcare providers to choose lower-cost alternatives when they are clinically appropriate. This can help in managing overall healthcare expenses.

Formulary Management:

Payment tiers are part of a formulary, which is a list of medications that a health insurer or state exchange covers. Formularies categorize Colorado health insurance medications into different tiers based on factors like cost, effectiveness, and availability of generic alternatives.

Patient Cost-Sharing:

Payment tiers also affect how much patients pay out-of-pocket for medications. Colorado health insurance medications on lower tiers typically have lower copayments or coinsurance rates, making them more affordable for patients.

Negotiation with Pharmaceutical Companies:

Insurers and state exchanges negotiate prices with pharmaceutical companies based on the Colorado health insurance medications’ clinical effectiveness and market competition. Payment tiers reflect these negotiated prices.

Click Here to view this Ian Young Health Insurance video about Keeping Docs and Meds On New Plan.

For assistance understanding payment tiers and balancing cost management with access to essential medications, email Ian Young Health Insurance or schedule an appointment today.