Woman overcoming depression

The Affordable Care Act (ACA) includes an important stipulation that positively impacts people with mental illness, and it has to do with prescription medication insurance. But how exactly does it help people with mental illnesses? Let HealthMarkets explain. In this article, we will give you a breakdown of the guaranteed prescription coverage you have under the ACA, the drug categories that dictate coverage, and how you can find coverage that matches your prescription needs.

Guaranteed and Equal Prescription Drug Coverage

The Affordable Care Act

First, let’s start with the Affordable Care Act’s 10 essential benefits. The ACA mandated that a minimum set of services must be offered by health insurance plans in order to become qualified for the Obamacare Marketplace. One of these services, and the one we will be focusing on, is prescription medication insurance.

In addition to requiring qualified health insurance plans to include prescription medication insurance, the ACA mandated that each prescription medication plan has to cover one medication from each category and class of drug listed in the United States Pharmacopeia (USP). This is a major benefit for those who take medications to treat mental illnesses. Why? Because the USP includes mental health drugs in its drug categories and classes, so these drugs must be covered (in some form) by your plan.

United States Pharmacopeia Mental Health Drug Categories
Anti-Addiction/Substance Abuse Treatment Agents
Bipolar Agents

To see all of the current USP drug categories, classes, and example drugs, click here.

The Mental Health Parity

Additionally, your mental health medications must be covered equally (both for treatment limits and costs) as other medications. Why? Because of the mental health parity. The mental health parity has been in place since 2008, ensuring that coverage of treatment for mental health and addiction is equal to other forms of healthcare treatments. For example, if a patient has unlimited coverage for diabetes medications, that patient must also have unlimited coverage for depression medications.

Coverage Differs in Prescription Medication Insurance Formularies

It’s important to mention that the ACA didn’t say that prescription medication plans had to cover every medication that falls under the categories above. Remember, each plan only has to cover one medication for each category and class of drug. But how are you supposed to know which specific medication your plan will pay for?

You can find out which prescriptions are covered from your plan’s drug formulary. A drug formulary is a list provided by prescription medication plans. It includes all of the prescription medications that will be covered by that plan during that year. You can find a plan’s drug formulary on the insurance company website, in initial plan paperwork, or by calling the insurance provider. A licensed health insurance agent may also be able to help you find a plan’s drug formulary.

Because formularies differ from plan to plan and year to year, it’s important to check your medications against a drug formulary regularly to keep your prescription costs low.

Can HealthMarkets Help You Today?

For more help understanding your prescription medication insurance or finding coverage that better fits your life, contact HealthMarkets. We can help you find plans that suit your needs, coverage that’s within your budget, and formularies that match your medications. Just give us a call today at (800) 304-3414, or contact a trained and licensed agent near you.

If you would like to learn more on your own first, feel free to visit our online resource center.



https://www.kyvoicesforhealth.org/blog/Category/3/Affordable-Care-Act/Article/11/10-Essential-Health-Benefits-Prescription-Drug-Coverage | https://www.usp.org/sites/default/files/usp_pdf/EN/healthcareProfessionals/usp_dc_2017_draft.pdf | https://www.nami.org/Find-Support/Living-with-a-Mental-Health-Condition/Understanding-Health-Insurance/What-is-Mental-Health-Parity

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