Prescription Help

Prescription Benefits and ACA Insurance Plans

All ACA Marketplace insurance plans include prescription benefits, but each plan varies on what medications are covered and what you can expect to pay out of pocket. To find out which prescriptions are covered through your Marketplace plan, you can visit your insurance company’s website or contact them directly. 

It’s important to get prescriptions filled at an in-network pharmacy to get the most coverage from your insurance plan. Some ACA plans also offer mail-order prescription services - contact your insurance company to get more information.

If you have any concerns about being able to afford your medication, it is important to talk with your doctor about possible alternative medications that may be more cost effective.

Generic VS Brand Name Medications

According to the FDA, generic medications cost on average 85 percent less than their brand name counterparts, but both generic and brand name medications go through the same FDA approval for sale in the U.S. Generic medications must meet the same quality and purity standards and have the same benefits and effects as their brand name counterparts. However, not all brand-name medications have generic versions. 

Cost is one of the main reasons many people choose to take a generic medication over the brand name. However, it’s important to talk to your doctor before taking the generic version of any prescribed medication. In some situations, your doctor may prefer that you take the name-brand medication. 

Ways to Save on Prescriptions

There are various programs that offer discounts for prescriptions, such as GoodRX, ScriptSave WellRX, and RXSaver. These discount programs cannot be used in conjunction with insurance benefits, but you can compare pricing between your insurance and the discounts available. Check out: The Ultimate Guide to Drug Discounts.

If you do not have health insurance, St. Vincent de Paul's Pharmacy program may be able to provide certain prescriptions by mail, free of charge. A list of provided medications can be viewed on their website by clicking "View Pharmacy Formulary."

Prescription Assistance Programs, which are often offered through pharmaceutical companies, are designed to help with the cost of name-brand medications for individuals who are uninsured or underinsured. The easiest way to see if financial assistance is available for your medication(s) is to search online for your medication’s name and “assistance program”. It’s important to note that each program’s enrollment and eligibility process varies. 

The Patient Advocate Foundation also has a case-management program and co-pay relief program for individuals living with a serious or chronic medical condition. The HealthWell Foundation also provides assistance for underinsured patients with chronic or life-altering diseases by helping out with prescription copays, health insurance premiums, deductibles, and coinsurance, pediatric treatment cots, travel costs, and behavioral health services.

Diabetes Resources

Do you need help with insulin? If so, please check out the insulin help resource from the American Diabetes Association. The Central Texas Diabetes Coalition also offers education and assistance, as well as a Prescription and Supply assistance list. The Wesley Nurse program offers free health education.