Pharmacist tells seniors how to avoid drug-store stress
by Barbara M. Morris, R.Ph.
Although you may have insurance coverage for prescriptions, getting a prescription
filled often can be stressful. But it's stress that may be eliminated with just
a little preparation.
The first step is to thoroughly understand what's in your benefits package and
to stay up-to-date on what your plan is doing. Benefits can and do change! (For example,
your co-pay or the days supply allowed may change.) If your benefits information
is confusing, here are just a few things to know and some questions to ask your insurer
that will help you take control of your medication needs:
Your pharmacist does not decide what your co-pay is or should be and has no way of
knowing for sure what it is until he sees what the insurance computer sends back
to his computer. The pharmacist sends Information about your insurance and your
prescription a computer that processes prescriptions for your insurer. Within
seconds, the insurance computer sends the co-pay to be paid by the customer back
to the pharmacy and it is automatically printed on a label.
- Not sure what your prescription co-pay is? Ask the benefits department at
your HMO or other insurance provider. Is there a dual co-pay? Do you pay one price
for generics and another for brands?
- Although you may have a member ID card with the co-pay(s) printed on it, that
information may not be current. The co-pay may have gone up. Read all mail you receive
from your insurer. Sometimes members consider this junk mail and envelopes are
thrown away unopened. When this happens, the next visit to the pharmacy may result
in an unwelcome surprise.
- What is your insurer's policy on brand and generic medications? Is there
mandatory generic substitution? If brands are allowed, will you have to pay more?
If so, how much more? Will your insurer honor your physician's request to dispense
a brand name medication when there is a generic available?
Morris is a practicing pharmacist in Escondidio, Calif.
- Understand your insurer's policy on days supply. Is it 30 days? 34 days? Can
you get 3 months supply for one co-pay? If there is a strict policy of "30 days only"
at a time, and you are going on vacation, will a vacation supply be allowed?
- Is there a "formulary" -- a list of medications the insurer will or will not
pay for? Must you pay a higher co-pay to get very expensive medications? What is
the policy when the doctor prescribes something not covered by your plan? The
best strategy in this situation is to ask for a copy of the formulary before you
sign up, and always get a copy after you are a member. When your doctor is ready to
prescribe new medication, ask him to consult your plan's formulary to be sure
it's covered. If it's not in the formulary and he is convinced nothing else will
help you, he can contact your insurer immediately. This will prevent a lot of stress
and save a lot of your valuable time.
- If you are getting medication through mail order and it doesn't arrive on
time, trying to get a supply (through your insurance) at the local pharmacy won't
work if the mail order pharmacy has already processed your order through their
computer. The computer network that processes and prices prescriptions is programmed
to intercept and prevent duplicate fills.
- Understanding benefit-related information is critical. It will go a long
way toward making every visit to the pharmacy a pleasant one. Your knowledge and
expertise will also make you your pharmacist's favorite customer!
(Last modified: Fri, Oct 09, 1998)
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