Do prescription drugs generally get covered under standard medical expense policies?

• A. Prescription drugs are never covered by major medical plans.
• B. Most major medical plans cover prescription drugs, though some require a separate rider or have formulary restrictions.
• C. Prescription drugs are only covered if purchased at a hospital.
• D. Prescription drugs are always excluded unless there is a pharmacy rider.

Answer: (B)

Prescription drugs are typically included in major medical plans as a standard part of coverage, meaning medications prescribed by a licensed clinician are generally covered and paid for after any deductible or co‑insurance applies. However, there are common limitations: plans often use a formulary, a curated list of covered drugs with different cost tiers, so some medications may have higher co-pays or may not be covered at all. Many plans also require prior authorization, step therapy, or substitution with a generic when available. In some cases, the prescription benefit might be obtained via a separate pharmacy rider. So, prescription drugs are usually covered, but the exact coverage and out-of-pocket costs depend on formulary restrictions, prior authorizations, and whether a rider is involved.