Your top 10 pharmacy questions, answered

June 09, 2026

Whether you take prescription medication every day for a chronic condition like asthma or only need one every so often when you’re sick, chances are you’ve had questions about your health plan’s pharmacy coverage.

Prescription drug coverage is the health insurance benefit people use the most, so understanding how it all works helps you feel more confident and comfortable taking care of your health — and best of all, it can help you save money.

Below are answers to 10 of the most common questions people often have about their prescription drug coverage, whether you buy your insurance through the Individual Marketplace, get it through your employer, or a Medicare Part D plan.

1. Why do some drugs cost more than others?

Some drugs cost more than others because they are newer or are brand-name drugs, meaning the cost of the research, development, marketing of the drug is still part of the cost. Other drugs may cost more to manufacture. Many drugs have generic alternatives that work just as well as brand-name drugs and will cost less.

2. What’s the difference between generic, brand name, and specialty drugs?

• Generic drugs are made with the same ingredients as equivalent alternatives to brand name drugs. They typically cost less. Example: amoxicillin
• Brand name drugs are typically newer, protected by a patent, and are priced higher than generics. Example: Zoloft
• Specialty drugs are often used to treat rare or complex conditions, are often more complicated to manufacture, and need to be handled by a specialty pharmacy. They typically are high-cost medications. Example: Humira

3. Why do I need a prior authorization for my medication?

Before you receive certain prescriptions, we ask your doctor to talk with our pharmacy teams about your treatment. This is called prior authorization or pre-approval. This process helps you be sure you’re getting the right care and to know that your medication will be covered based on your plan’s benefits. To see which prescription drugs and medical services need to be approved in advance, click here. 

4. How can I save money on my medications?

If your medicine is too expensive, talk with your doctor or pharmacist. They may be able to suggest a lower-cost option that works just as well. Many health insurance plans, including Florida Blue, also offer tools to help you compare what you might pay out of pocket. Log in to your online member account to use Florida Blue’s cost comparison tool. If you’re on Medicare, ask about programs that may help with prescription costs, including Extra Help for people who qualify, or the Medicare prescription drug payment plan.

5. Why are some drugs covered and some drugs are not?

Like most health plans, Florida Blue works with a committee of physicians and pharmacists to review medications that should be added to the covered drug list of its plans. The medication list is reviewed quarterly to examine new medications and new research and information about medications that are already on the market concerning safety, effectiveness, and current use in treatments.

6. Why should I get a 90-day supply of my medication instead of a 30-day supply?

Getting a 90-day supply of your medications you need to take every day helps you stay on track because you won’t need to get as many refills. This lowers the chance you’ll forget to take your medication.

7. Why do I need to use certain pharmacies?

Your health plan works with select pharmacies to make sure you get the best prices for your prescription drugs.

8. What is step therapy?

Sometimes your doctor may prescribe a newer drug when there is a lower cost, well-studied alternative. Your health plan may ask you to try the more proven therapy before starting a newer medication. This is called step therapy.

9. Can I appeal a coverage decision?

Yes. If you or your doctor disagree with your health plan’s decision not to cover a prescription, you can appeal the decision. Log in to your online member account or call the number on the back of your member ID to get started.

10. Are there any programs to help me if I take specialty medications or a lot of medications?

Yes. Depending on what Florida Blue plan you have, you may qualify for our Advocate+ Pharmacy Match program if you take specialty drugs. Some members may also be eligible for the FlexAccess program to help with copay costs, depending on which plan you have. The program helps match members with a specialty pharmacy that can help them fill their medications at a lower cost. Medicare Advantage plan and Medicare Part D plan members who take multiple medications may also qualify for the Medication Therapy Management Program to help them manage their medications and make sure they’re working well and don’t interact.