Do health plans cover cost of insulin, diabetes medicines?

livemint.com:

—Name withheld on request The industry has slowly begun catering to the specific needs of such customers. A few health insurance providers prioritize comprehensive coverage for individuals managing diabetes. These policies typically include coverage for insulin and essential diabetes medications within the prescription drug coverage section.

There is also an emphasis on encouraging the use of cost-effective generic medications whenever possible. However, insurance providers understand that certain individuals may require specific brands or types of insulin for medical reasons. In such cases, they at times collaborate with healthcare providers to ensure coverage for medically necessary medications.

Insurance providers typically maintain a formulary, which is a list of drugs covered under their plans. Diabetes medications, including insulin, are typically part of this formulary, and they may be categorized into different tiers that impact cost-sharing requirements for policyholders. To ensure that prescribed treatments align with best practices for diabetes management, insurance policies may require prior authorization for certain medications, including specific types of insulin.

Some insurance providers may also implement step therapy protocols to promote the use of cost-effective medications initially. However, they remain committed to accommodating patients’ needs when healthcare providers deem a particular medication as essential. Policyholders are typically responsible for a portion of their medication costs, which can take the form of co-payments or co-insurance, depending on the specific terms and conditions of the policy.