How to tell if your prescription drugs are covered

Prescription drugs

You might have a health plan that covers prescription drugs. But no health plan covers all prescription drugs. So how can you tell if the medication you need is covered? The answer is simple: check the health plan’s formulary.

Formu-whatnow? The formulary. It’s a list of covered drugs that each health plan develops for its customers. They can vary from plan to plan, and for sure among health insurance companies. That’s why it’s so important to check the formulary for your specific health plan.


Click the links below for examples of the formularies for various WPS Health Insurance health plans. If you are a WPS customer, one of these might be the one that applies to you. If you’re not sure, or if you have questions, you can call the Customer Support number on your customer ID card for information. If you are not a WPS customer, you can ask your health insurer for a copy of the formulary for your health plan.

WPS MedicareRx Plan (PDP) 2019 Formulary

WPS MedicareRx Plan (PDP) 2020 Formulary

WPS 2019 short-term health plans

WPS 2019 individual health plans

WPS 2020 individual health plans

WPS 2019 large group health plans

WPS 2020 large group health plans

WPS 2019 small group health plans

WPS 2020 small group health plans

Prior authorizations

It’s important to know that some prescription medications require a prior authorization to determine if they are eligible for coverage. This ensures the appropriate use of certain drugs and allows WPS Health Insurance to determine if a drug meets the medical necessity requirements of your policy. You can find the WPS list of drugs that require prior authorization on our website. If you have our Medicare Part D plan, the list is different; you’ll find the 2019 WPS MedicareRx Plan list here and can take a peek at the 2020 WPS MedicareRx Plan list here.

There’s an app for that

For easy access to information on the go, WPS’ partner, Express Scripts, offers a mobile app you can download from your device’s app store. Just search on “Express Scripts” and download it. The app gives you real-time order status information, offers handy dose reminders, and helps make your life easier.

You can also use the Express Scripts website to access medication pricing, manage prescriptions and refills, find a pharmacy near you, and more. Register for your account to get started.

Avoid surprise bills

If you don’t check the formulary, your prescription medication may not be covered. And nobody likes surprise bills. To help keep control of your budget, make sure you review your formulary so you’re fully informed. If your doctor prescribes a drug that isn’t covered, have that doctor take another look to see if there’s a comparable drug on the formulary. It might save you some money.

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