Do yourself a favor and KNOW your insurance coverage. Not being fully informed can cost you hundreds if not thousands of dollars.



TO REDUCE INSURANCE PROBLEMS and MISUNDERSTANDINGS:

1. Have a copy of your insurance's formulary.

What is a Formulary?

A formulary is a list of all the medication your insurance will help you pay for. This list does change over time, so make sure to have the most up to date edition. On a formulary, the amount you're expected to pay is your co-pay.

Most insurance formularies are in levels or tiers.

EX: Tier 1 Generic Medication

Tier 2 Preffered Medication (Brand)

Tier 3 Non Preffered Brand Medication

Price generally escalates with increasing Tier position.

Also note that Tier 2 and 3 are both brand name medication. That is, there may be more than one brand name medication for the same condition. Your insurance may have a prefference.

So...

Ask your insurance to mail you a copy of your current formulary. You can also ask your insurance carrier where you can find a copy of your formulary online. If you have more than one insurance carrier, make sure you have access to each individual one.

ALWAYS go with a copy of your formulary to your Dr.'s office, or leave it with them. It will save you a potential headache and surprise at the pharmacy.

WHAT IF A MEDICATION IS NOT ON THE FORMULARY?

Don't give up yet!! You can ask your Dr. directly, or your Pharmacy to conduct a Prior Authorization for you.

What is a Prior Authorization?

Usually in reference to non-formulary medication, but can also refer to non-formulary directions - For example your insurance carrier may only cover 30 pills of a medication within a 30 day period, but your Dr. prescribes it for twice a day (60 pills within 30 days).

If your doctor prescribes a drug that requires prior authorization for coverage, ask your doctor to call the number on your Prescription Insurance card to begin the authorization process. Your doctor's office must complete a prior authorization form or call your Insurance at the number on your card to provide the necessary information.

And lastly, some insurance plans have preffered pharmacies. So make sure that your regular pharmacy is a participating pharmacy. This is usually not a big deal especially in regards to most retail pharmacies, but to be safe, call your insurance company to make sure. Getting medication filled at a non-participating pharmacy will cost you more!

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