Students arriving at the WSSU Wellness Center Pharmacy with prescriptions are required to present proof of insurance; typically this means presenting their medical card, though some medical plans include prescription coverage as part of their coverage and may produce a separate card for this coverage.
Understanding how insurance works can save time and money when visiting pharmacies, so here are five tips to make you better prepared when entering that pharmacy door:
Know Your Coverage
One could visit a pharmacy for any number of reasons, from treating an ear infection with antibiotics to lowering blood pressure with medication. Whatever your motivation, it’s always beneficial to understand how your insurance works at pharmacies in order to be well prepared when filling a prescription.
One of the first questions a pharmacist will ask you for is your insurance information. In most cases, this will include providing them with both your card and a valid prescription from your doctor. Furthermore, you should familiarize yourself with your plan’s formulary which is a list of drugs covered by insurance; there may be different levels of coverage (tiers) depending on which drug it covers as well as possible associated costs and restrictions that might apply.
Many pharmacies provide patients with a chart showing them what their copay will be for each prescription drug, making this an invaluable tool to save them money when purchasing medications at the pharmacy. It’s important to keep in mind, though, that this chart may not always provide accurate estimates; always double-check with your pharmacist first if assuming specific copay amounts are accurate.
Most medical insurance plans include prescription cards in their benefits package. The prescription insurance company information will typically be displayed prominently at the top right corner. Sometimes medical insurers outsource prescription coverage to another company, and customers might receive separate prescription benefit cards from these entities – which could cause confusion at pharmacies if customers don’t realize their prescription information is already on their primary medical insurance card rather than this additional one.
As with other health plans, TRICARE includes other health insurance (OHI). To see if an OHI coverage fits with your prescription drug benefit in TRICARE, call the member services phone number listed on your eligibility letter or enrollment card and speak to an advisor.
Know Where to Get Your Prescriptions
Visits to the pharmacy can be daunting experiences when you don’t fully comprehend your insurance or how it interacts with your prescriptions. Pharmacy visits should not be stressful experiences as this is where patients obtain medicine to treat ailments like strep throat or high blood pressure, as well as purchase over the counter (OTC) drugs like painkillers and antihistamines. They are typically located inside grocery or large chain stores. Most insurance plans include a list of pharmacies covered under their plans called “formulary”, so it is crucial that patients use only covered pharmacies so they avoid incurring extra copays or not receiving medication altogether.
Ask your physician to substitute an affordable generic drug in place of the brand-name medication prescribed, which will save money. In addition, seek manufacturer coupons which may lower the price of medication; these may be available through either your physician or online resources – although this requires some detective work on your part to discover.
If you have other insurance that covers your prescriptions in addition to TRICARE, such as employer or private coverage that covers them as well, such as group numbers and I.D. numbers on your card back, make sure the pharmacist has all of the appropriate information in order to bill that other insurer, such as group number and ID information from TRICARE card back. Many people don’t realize they have additional coverage through employers or private policies which is known as Other Health Insurance or OHI; if it has separate drug benefits it may have its own BIN or RxBin number that differs from TRICARE card numbers on card back.
Consider visiting a non-chain pharmacy that’s in-network with your insurance, such as a military base clinic or community-based organization like St. Vincent de Paul. These could prove less costly and more convenient. In addition, online pharmacies typically offer 90-day supplies at reduced copays than traditional stores.
Know Your Copays
If you use a prescription drug insurance card, the pharmacy will run your medications through an insurance company before dispensing them – known as formulary pricing – which gives the pharmacy an estimate price for dispensing each medicine. In certain instances, some may need prior authorization from your physician; therefore it’s wise to contact your drug plan to see whether this applies in your situation.
Many pharmacies will offer discounted generic versions of your medication that could save money during deductible or coverage gaps, making this an especially helpful solution. Since certain discounts may only be available during certain seasons of the year, it’s wise to consult your drug plan first before making your purchases.
Check into programs offering copay cards for prescriptions, often offered by pharmaceutical companies and available to learn more from online searches. These may be good options if you have private drug insurance or Medicare plans available to you.
Pharmacy employees should always remain alert for billing errors that could result in audits or chargebacks, particularly rejection for look-alike or sound-alike medications, miscalculating days’ supply (especially high cost or difficult dosage forms like eye drops, inhalers or insulin) which leads to chargebacks and audits. One common error involves rejecting similar-sounding medicines. Another chargeback-prone error involves miscalculating days’ supply – especially for high cost or difficult dosage forms like eye drops, inhalers or insulin).
PBMs take care to negotiate an appropriate rate that covers drug costs, dispensing fees and markup; any time that patients overpay this negotiated rate they incur an overpayment charge which typically results in higher-cost drugs being overbilled or being invoiced more by PBMs for identical medications.
To prevent overpayments, the best way to prevent overpayment is to compare cash prices before paying in pharmacy; you can do this through GoodRx’s site to see if there may be better offers available elsewhere.
Know Your Rights
Pharmacys play an essential part of health care delivery systems. Millions of people live within five miles of one, making it their go-to provider and filling billions in prescriptions annually.
Hearing that your medication isn’t covered by insurance can be both discouraging and upsetting, but there are steps you can take to ease the situation and potentially save money on medications.
First, check with your pharmacist to ensure they have your most recent insurance information on file for you. Sometimes claims are denied because drugstore computer systems contain outdated or incorrect data; additionally, many insurers advise their members to only utilize pharmacies within their preferred network and failure to do so may lead to your claim being declined.
Get in touch with your pharmacist to verify the formulary of your insurance plan, which lists which drugs your insurer covers. Sometimes insurers exclude certain versions from coverage; your pharmacist could potentially contact your insurer and request that their policy change.
If your medication isn’t covered by your insurance, ask for a cash discount from your pharmacy. Independent pharmacies typically have more flexibility when negotiating prices with insurance providers, so you could find lower prices at independents than at large chain stores. Furthermore, ask to pay cash rather than using insurance altogether–it’s perfectly legal and may save money!
