Ortho Evra

[Guest bigriff]

Hope this is an acceptable place to ask whether Ortho Evra is a covered expense or not. I was surprised not to find it on the list offered at pacificbenefits.com. It has birth control pills, but not this one...

So is not covered then, or is my reference list not complete?

Another thought I had was just if it is a diferent category, like a prescribed med? Is that how it works? I don't see a lot of medications listed, but presume they are if prescribed and my insurance doesn't cover it.

I'm new to this so please excuse my lack of knowledge here, just trying to figure out if this is worht it or not and I have limited time and info.

Thanks!

[Guest gdburns]

You are primarily wondering what happens "if prescribed and my insurance doesn't cover it" ?

Pacific Benefits is not your insurance company, so Why use their list first? Isn't your insurance company the Primary Payer if you filled a prescription for this item? Your insurance company maintains a list of covered/ accepted items which is referred to as their Formulary. I suggest that you find out if it is covered in the insurance company's Formulary. A Formulary list should have been provided to your company. You also can contact the insurance company or the agent.

Pacific Benefits probably administers your FSA. Your FSA would probably come into play if your insurance company does not fully cover the cost of the prescription. Many FSA lists of covered items are not very specific and use categories or simply refer you to an IRS Publication.

Bear in mind that it is very difficult, if not impossible, for any list (especially on-line) to be kept up to date. There are just too many items, with new products being available and old ones being discontinued on a daily basis. So there will be many items that are covered which will not be on any list that is available to you. As a result you have to first see if the general category is covered, then ask someone with the authority to give a definite answer.