In most prescription drug plans, which statement is true?

In most prescription drug plans, which statement is true?

• A. Plans limit which medications are covered
• B. All medications are covered without exception
• C. Only over-the-counter drugs are covered
• D. Coverage starts immediately with no out-of-pocket costs

Answer: (A)

Plans commonly operate with a formulary—the approved list of medications the plan covers. Because of this, they limit coverage to drugs on that list and may add restrictions like prior authorization or step therapy, or require higher copays for non-formulary options. This means not every medication is covered, and patients may need to use a formulary-listed drug or obtain an exception. Coverage also involves out-of-pocket costs such as deductibles or co-pays, so it does not typically start at zero. OTC drugs aren’t the main focus of these plans, and not every prescription is automatically covered. That’s why the statement about plans limiting which medications are covered is true.

Plans commonly operate with a formulary—the approved list of medications the plan covers. Because of this, they limit coverage to drugs on that list and may add restrictions like prior authorization or step therapy, or require higher copays for non-formulary options. This means not every medication is covered, and patients may need to use a formulary-listed drug or obtain an exception. Coverage also involves out-of-pocket costs such as deductibles or co-pays, so it does not typically start at zero. OTC drugs aren’t the main focus of these plans, and not every prescription is automatically covered. That’s why the statement about plans limiting which medications are covered is true.