Insurance Education

Clarifying coverage so you can focus on your health.

Complex insurance processes can add to uncertainty you may already be feeling after your diagnosis. These resources can help you understand common coverage concepts.

Understanding Your Insurance Plan

Getting your medications covered starts with knowing what type of insurance you have.

Commercial Insurance

If you’re commercially insured (often through an employer or private plan), your coverage rules are set by that insurance company.

Learn more about insurance and the Prior Authorization process

Uninsured or Underinsured

If you don't have insurance or you have inadequate coverage, we can provide information on assistance programs.

Affordable Care Act Plans

Health plans available under the Affordable Care Act may be able to help you pay for your healthcare, including prescription medications.

Learn how your plan may cover prescription medications

Not sure where to start? Check out our Useful Terms section at the bottom of this page.

Jump to Useful Terms
Couple reviewing Medicare & You Guide on a laptop

Government-Funded Insurance

If you are insured through programs such as Medicare, Medicaid, or Tricare, coverage is determined by the government.

Government-funded insurance may cover part of your medication costs.

If you have government insurance, you are not eligible for the Axsome OnMySide Savings Card. However, we can provide information about independent charitable foundations that may be able to provide financial support or you may be able to take advantage of other government programs.

To learn more about Medicare, download the Medicare & You Guide. It has important information about all parts of Medicare, including Part D.

The Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan helps people with Medicare Part D or Medicare Advantage drug coverage manage their out-of-pocket prescription costs by spreading payments over the calendar year instead of paying the full amount at the pharmacy.

To participate, you must contact your specific Part D or Medicare Advantage drug plan using the member services number on your insurance card.

The out-of-pocket maximum for prescription drugs covered by Medicare is $2,100 in 2026.

Watch a short Medicare.gov video

You can also call 1-800-MEDICARE (1-800-633-4227) for general assistance.

Woman watching Medicare.gov video on a tablet

Medicare Extra Help Program

The Low-Income Subsidy, also known as Medicare Extra Help, can help qualified patients pay less for premiums, deductibles, and copayments under Medicare Part D.

Eligible patients may pay reduced premiums and deductibles, and only small copayments for covered prescriptions. Copayment amounts are updated annually.

Patients who are enrolled in or eligible for a Medicare Part D prescription drug plan, reside in the U.S., and meet certain income and resource limits may qualify for this program.

Learn more about the Extra Help Program

What You Need to Know About Prior Authorization

If your insurance requires Prior Authorization (PA), there is an extra step before you can pick up your medicine at the pharmacy. Here's what to expect.

Why Is It Required?

Insurance companies need to make sure certain medicines are really needed before they pay for them. This doesn't always happen, and it doesn't mean your medicine is being denied.

Who Handles It?

Your doctor's office or pharmacy will fill out the extra forms. Your insurance company might contact you with questions, so keep an eye out so there are no hold-ups.

What Happens Next?

If your Prior Authorization is approved, you are all set to start your medicine. If it is not approved, don't worry. Most insurance companies have an appeals process.

Questions about appeals? 

Call the Axsome OnMySide Team
Monday - Friday, 8 AM - 8 PM ET, at 1-800-805-8621.

Contact both your doctor's office and insurance company.

Useful Terms

These are terms you may encounter when navigating insurance.

Appeals
A formal request asking your insurance company to review and reconsider a decision that denied coverage or payment for a prescription medication.
Catastrophic Coverage
A stage of Medicare Part D where your costs are significantly reduced after you have spent a certain out-of-pocket amount on covered drugs during the year.
Coinsurance
Your share of the cost for a covered prescription, expressed as a percentage of the total allowed amount for that medication.
Copay
A fixed dollar amount you pay for a covered prescription at the pharmacy, regardless of the medication's total cost.
Covered Part D Drug
A prescription drug included on your Medicare Part D plan's list of covered medications, known as a formulary.
Deductible
The amount you pay out-of-pocket for prescriptions before your insurance plan begins sharing the costs with you.
Extra Help (or Low-Income Subsidy)
A Medicare program that helps people with limited income and resources pay Medicare Part D prescription drug costs, including premiums, deductibles, and copays.
Federal Poverty Level
An income measure published annually by the government, used to determine eligibility for programs like Medicaid and Extra Help.
Inflation Reduction Act (IRA)
A federal law that made significant changes to Medicare prescription drug pricing, including caps on out-of-pocket costs and allowing Medicare to negotiate certain drug prices.
Initial Coverage Phase
The period in your Medicare Part D plan after your deductible is met, during which you pay standard copays or coinsurance for covered drugs.
Medicaid
A joint federal and state health insurance program for people with limited income and resources, which may also cover prescription drugs.
Medicare
A federal health insurance program primarily for people age 65 and older, and certain younger people with qualifying disabilities or conditions.
Medicare Part C (Medicare Advantage)
An alternative to Original Medicare offered by private insurance companies that may bundle medical coverage and prescription drug benefits together.
Medicare Part D
The Medicare program that provides prescription drug coverage through private insurance plans approved and regulated by Medicare.
Medicare Prescription Payment Plan
A Medicare program that lets beneficiaries spread their out-of-pocket prescription drug costs into equal monthly payments throughout the calendar year.
Open Enrollment
A specific period each year when you can sign up for, change, or drop your Medicare or other health insurance coverage without a special reason.
Out-of-Pocket Costs
The total amount you pay directly for covered prescriptions and health services, including your deductible, copays, and coinsurance.
Part D Plan Sponsor
A private company that has a contract with Medicare to administer a Part D prescription drug plan to enrolled beneficiaries.
Premium
The amount you pay for health insurance each month, including Medicare Part D, under a plan premium.
Prior Authorization (PA)
A requirement from your insurance company that your doctor obtain approval before prescribing a specific medication in order for it to be covered.
Prescription Drugs
Medications that legally require a clinician's order to dispense and may be covered under your insurance plan's formulary.
Prescription Drug Plan (PDP)
A stand-alone Medicare insurance plan that provides prescription drug coverage, typically used by people enrolled in Original Medicare Parts A and B.