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:
  • 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?
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.
  • 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!
          Morris is a practicing pharmacist in Escondidio, Calif.
(Last modified: Fri, Oct 09, 1998)
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