Know Your Insurance

If you have had an issue with your prescription insurance in the past, you are not alone. As you may have encountered, insurance is an ever-changing process. There is great variability among insurance providers in what, when, and how they cover prescription drugs. While we may not be able to solve all of your insurance problems on this site, we do hope to provide you with a few tips to ensure a smooth trip to the pharmacy.

1. Keep Your Most Recent Insurance Card With You

Your insurance may send you a new card each year, possibly more often if changes are made to your plan.

2. Your Health Insurance Card May Not Be The Same As Your Prescription Benefits Card

Many insurance companies utilize Pharmacy Benefit Management companies (PBMs). These companies often (but not always) will issue a separate card for use at your pharmacy.

3. Know Your Formulary

Most prescription drug plans follow a 3-tier plan, with generic drugs as your lowest co-pay and non-preferred brand name drugs set at a high-dollar amount or large percent co-pay. Most insurance companies send a prescription formulary with your cards or you can access the list online.

  • Tier 1 – generic
  • Tier 2 – preferred brand name
  • Tier 3 – non-preferred brand name (may require a lengthy prior-authorization process for payment)

4. Be Aware of Yearly Changes

Your deductable is renewed every year, or you may notice that your co-pays are higher than the previous year; these are just a few of the many changes that can occur yearly.

5. Prior-Authorizations

These are often lengthy processes and, many times, your doctor needs to get approval from your insurance. We will contact your doctor to help facilitate this process, but it may be helpful if you call your doctor as well.