5 Questions to Prepare You for Your First Trip to the Pharmacy on Your New Health Insurance Plan

When your insurance plan changes, it’s not uncommon to be slightly disoriented the first time you visit the pharmacy for your regular prescription(s). Here are 5 ways to be more prepared walking in the pharmacy door.

1. How does the pharmacy get your new insurance information?

To fill a prescription, the first thing the pharmacy will need is your new insurance information. It’s important to provide the pharmacist with your new insurance I.D. card so they can verify your prescription benefit and copays with your insurance carrier.

If you’re officially enrolled in your new plan, but your insurance card hasn’t arrived in the mail yet, it might be possible to print off and use a temporary card. Contact your broker for more information about your medical insurance carriers process.

2. What if you do not have your I.D. card?

If you do not yet have either your I.D. card or temporary I.D. card ask your pharmacist if you can do a partial fill of your prescription medication. Some pharmacies will reimburse you the cost of your medication if you provide them with your new I.D. within a certain timeframe (usually 7-14 days however you will want to check with your pharmacy directly).

In some cases, you may need to pay the full amount out of pocket and get reimbursed once you have your card in hand. If you do happen to have your I.D. and group number, the pharmacist may be able to run your prescription through the claims system; they will need to have both a “BIN” and “PCN” number in order to do that. If this is the case, you will want to contact your HR department who can check with your broker.

3. What is a “tier” and how does it work?

Drug lists are typically divided into different categories or “tiers”. Usually these include: generic, preferred, non-preferred and specialty medications. The  copayment you are responsible for paying at the pharmacy is determined by what tier level your medication falls into.

4. What is prior authorization and why is it important to me?

There will be some drugs on the insurance carriers “formularies” (i.e. drug list) that will require a prior authorization. The insurance carriers want to be sure that you are getting the most cost effective drug for your condition.

You may need to meet certain requirements or try one of the more preferred drugs before your insurance carrier will approve the drug you are requesting. Typically if a drug requires a prior authorization it is identified on the formulary. These drug lists can be found on the insurance carrier’s website.

5. Have you considered using mail order?

If you take a daily maintenance medication, you may want to consider getting your prescriptions through mail order. Most insurance carriers will allow for a 90-day fill of your prescription medication at a reduced copay or coinsurance. Refills are easy, as you can usually order online or via phone and the medication are delivered right to your home, saving you time and money.

To start this process, you will need to complete a mail order form and will also need to ask your doctor for a new prescription. Let him/her know that you will be using mail order so he/she will write it for a 90-day supply.

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Your first trip to the pharmacy after an insurance plan change doesn’t need to be overwhelming. Get prepared by reviewing the 5 questions above and you’ll be able to get the medication you and your family need covered by your insurance carrier.