Have you ever found the experience of understanding prescription benefit plans intimidating? Ever found out the hard way a prescription was not covered, or needed a prior authorization, or had quantity limitations before it could be filled? I know I have, and a basic list of questions would have relieved frustration, time wasted waiting for approvals, improved efficiency, and given me a better understanding of how my plan worked before going to the pharmacy.
A basic list of best questions to ask my Prescription Benefit Management Provider would have been ideal at the beginning of my plan year so I could have asked ahead of time and been forewarned, and forearmed before trying to fill my prescriptions. Prescription benefit plans can be independently obtained, or can be part of your employee benefits. Locating who is your Prescription Benefit Management Provider and any materials provided when your benefit year begins will give you the phone numbers to contact your benefit provider.
If you answered yes to any of the above questions, then I have good news! Now there is a list of questions you can ask your Prescription Benefit Management Provider when understanding your prescription benefit plans. This list of questions will develop a better understanding of how your benefits work, and how to make them work the best for you.
Here are just a few questions you will find:
1. Are there any refill limitations on maintenance medications for my plan?
2. Am I required to do mail order on maintenance medications, or can I continue to fill at the local retail pharmacy?
3. Is there any cost savings when filling prescriptions through mail order versus retail?
Understanding your prescription benefit plan helps you make your plan work the best for you. Knowing what limitations apply, and if further action needs to be taken with you and your doctor with prior authorizations or appeals processes can drastically reduce frustration, time, and money. No one likes to pay full price out of pocket for medication if there is any way it can be covered by your insurance. Basic questions can help cover major points to your prescription benefit plan, and while discovering this information, it may lead to more specific information provided by your Prescription Benefit Management Provider. Knowing the correct information for your Doctor's office or pharmacy to submit for prescriptions and claims can reduce time spent waiting for prescriptions.
Here are some helpful Hints:
When calling for refills, call before the weekend in case the pharmacy needs to contact your physician for additional refills. This way if you only have a few days of medication left, it will provide time if there is a problem with limitations or refills so you are not without medication, or finding yourself paying full price for it.
Also check the Internet for a manufacturers' coupon on the medication, it could help save you more money at retail if you have to pay more than you normally would.