01
Review your plan documents
Look for the current formulary, drug-coverage rules, and member-services number on your insurance card or plan website.
Insurance and coverage
Understand coverage before you call.
A practical guide to pharmacy coverage, formularies, and prior authorization for FDA-approved medications.
Start here
Coverage can change. Your plan is the source of truth.
02
Ask your insurer the right questions
Use the questions below to understand the plan's current rules before relying on any coverage expectation.
03
Discuss options with your clinician
If a clinician determines treatment is appropriate, the clinical team can manage prior authorization and support an appeal after a denial.
Member-services call list
Five questions to bring to your insurer.
Write down the date, representative's name, reference number, and any instructions they give you. Coverage information can change, so ask for the current plan rules in writing when possible.
- 01
Is the prescribed medication on my plan's formulary for my age and diagnosis?
- 02
Does my plan require prior authorization, step therapy, or documentation of another treatment first?
- 03
What clinical criteria and supporting records does the plan require?
- 04
Which in-network pharmacies can fill the prescription, and what is my estimated pharmacy cost?
- 05
If coverage is denied, what is the plan's appeal process and deadline?
A clear clinical boundary
Coverage does not determine clinical care.
Enrollment does not guarantee clinical acceptance, treatment, medication, or insurance coverage. The licensed clinician makes independent clinical decisions. Medication, laboratory, and pharmacy costs are separate from Thryvwell membership.