Prescription Medications

Prescription Medications and Underwriting

Before the health reform law was in place, insurance companies reviewed the medications taken by an applicant in addition to their medical history. To determine the cost of premiums, the price of some prescription medications would be taken into consideration, as the medication cost may have been too costly to cover.

Once medical history and prescriptions were evaluated, several actions may have been taken: offering the applicant enrollment at a higher level than their initial request, suggesting a different plan, or decline them coverage altogether. This is not possible any longer, as insurers are not permitted to discriminate against any applicant for health reasons. No underwriter should ask for your medications when you apply for a health insurance plan. However, this is what applying for health insurance was like before Obamacare.

The following was considered when evaluating risk for prescription medications:

  • Projected payment for medication(s) monthly
  • Whether they use brand name or generic
  • Medication benefit of the plan applied for
  • The plan that has been applied for

Certain medications would not affect the premium or level of coverage, such as:

  • Non-drowsy antihistamines like Zyrtec, Claritin, and Allegra
  • Short term antibiotics (under 21 days)
  • Birth control pills
  • Thyroid hormone replacements
  • Female hormone replacements

Declinable Medications List

If the applicant was taking any of the following medications, or had taken in the 12 months prior to applying, they would be declined health coverage in most states by most health insurance companies before the ACA. Medications not on this list were to be investigated so to identify the condition for which the medication was needed and prescribed.