Prescription Benefits — Common Questions

Below you'll find a list of frequently asked questions related to your prescription benefits.* You can also view other current member-related FAQs to see questions and answers about understanding your plan, finding providers in your network, billing and claims, and renewals.

MEMBERS — Prescription Benefits

Q: What prescriptions are covered on my plan?
Q: How can I save on prescriptions?
Q: What is the difference between brand and generic prescriptions?
Q: What are preferred and non-preferred brand-name drugs?
Q: What happens if I use a brand-name drug when a generic is available?
Q: What is a specialty pharmaceutical?
Q: How does the prior authorization program work?
Q: Why should I use CVS/Caremark, the pharmacy benefit manager?
Q: Why do some drugs have quantity limits?
Q: What is step therapy?


Q: What prescriptions are covered on my plan?

To better understand the prescriptions covered on your plan, use the 2016 Prescription Drug Guide to help you quickly find:

  • Generic, specialty, preferred brand and non-preferred brand drugs by category
  • Which drugs require preauthorization
  • The cost sharing on drugs that may be covered by your plan

View the 2016 prescription drug guide PDF Icon

Note: This drug list provides summary information and is subject to change. For a complete listing of benefits, exclusions and limitations, please refer to your plan benefit details.


Q: How can I save on prescriptions?

With an Assurant Health plan, there are a few ways you can save on prescription drugs.
  • Use the CVS Caremark prescription program
  • Take advantage of generic prescriptions

Learn more about how you can save on prescription drugs


Q: What is the difference between brand and generic prescriptions?

Generic drugs are chemically the same as their branded counterparts. They are also the same in dosage, safety, strength, form and intended use. Generic drugs are only available after the FDA approves them. When filling your prescription, your pharmacist can substitute a generic drug for a brand-name drug when the generic is rated by the FDA as equivalent and also where it is permitted by your doctor and state law.


Q: What are preferred and non-preferred brand-name drugs?

  • A preferred brand-name drug is considered a preferred brand-name drug based on its proven clinical and cost effectiveness.
  • A non-preferred brand-name drug is a medication where there is a more cost-effective drug available that is clinically the same.



Q: What happens if I use a brand-name drug when a generic is available?

If you choose to use a brand-name drug, rather than its generic or bio-similar equivalent, you will be responsible for paying the brand-name cost-sharing amount, such as deductibles or copays. You will also be responsible for paying the difference in cost between the brand-name drug and its generic or bio-similar equivalent (this is called an ancillary charge). The ancillary charge will not be reimbursed by Assurant Health, nor does it count toward satisfying any coinsurance, deductible or other out-of-pocket limit. Not applicable in all states.


Q: What is a specialty pharmaceutical?

These are prescription drugs used to treat rare or certain chronic diseases, such as rheumatoid arthritis, HIV/AIDS, multiple sclerosis, cancer, hemophilia and hepatitis C. Usually, these are not dispensed at a local retail pharmacy. If you have a complex condition that requires a specialty pharmaceutical (a specialty medication) - you can maximize the benefits of your plan, by using Assurant Health's designated specialty pharmacy, CVS Caremark.

Learn more about specialty pharmaceutical coverage


Q: How does the prior authorization program work?

The Prior Authorization program encourages appropriate and cost-effective use of drugs, and:
  • A physician, a patient, or a person appointed to manage the patient’s care must request prior authorization before drugs that require a prior authorization may be considered for coverage under a member’s pharmacy benefits plan. If the request is approved, the drug will then be covered at the applicable costs associated with the member’s plan
  • The Prior Authorization program is based upon current medical findings, FDA-approved manufacturer labeling information and cost
  • The drugs requiring prior authorization are subject to change

Learn more about the pharmacy preauthorization process

For more information, call the customer service number on the back of the member ID card. For a prior authorization request, call the Prior Authorization number on the back of the member ID card.


Q: Why should I use CVS/Caremark, the pharmacy benefit manager?

As your pharmacy benefit manager, CVS/Caremark brings you discounts on prescriptions and processes prescription claims. Their nationwide network has more than 65,000 independent and chain pharmacies, including CVS, Target, Walgreens, Walmart and Rite Aid stores.

You can save an average of 30-40% on prescription drugs at a CVS/Caremark participating pharmacy; any drug discount will already be applied. Your pharmacist will charge you the amount you’re responsible for paying (such as any applicable copay, coinsurance or deductible). Make sure your plan provides coverage by reviewing the Prescription Drug Card Program information in your insurance contract, or by contacting us.

In most states, CVS/Caremark will deliver to your home any prescription drugs you’re using on a long-term basis. It’s convenient, and you may even save money. Call CVS/Caremark or visit caremark.com for more information.

You can learn more about how to manage your prescriptions with CVS Caremark by visiting our Current Customers web page at assuranthealth.com.



Q: Why do some drugs have quantity limits?

Your plan may limit the amount of a drug you can receive at one time. These limits help your doctor and pharmacist check that the drugs are used appropriately while promoting patient safety. We use medical guidelines, FDA approval and guidance from drug makers to set these quantity limits.


Q: What is step therapy?

With step therapy, you must try one or more alternate drugs before a Step-therapy drug. The alternate drugs are FDA-approved, treat the same condition(s) and may also be available to you at a lower copay or coinsurance level.

View the full list of FAQs for Assurant Health members

*Note: This information applies to the prescription benefit coverage available with Assurant Health Major Medical plans that started on or after January 1, 2014. If you have a Short Term Medical plan or a non-metallic or grandfathered Major Medical plan, you can find more details about your plan’s prescription coverage within your plan documents, or by calling the phone number listed on your ID card.