Deborah DaPore, RPh, talks about how to make sure your prescription medication is covered by your insurance plan.
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First thing they need to do is to get a copy of their formulary. They need to take that to their doctor because the doctor then will evaluate the drugs on the plan and the insurance carriers will have several different drugs that do the same exact same thing for its different disease states and that list them in their formulary. So the patient then and the doctor can choose which drug they can afford and which drug is going to work the best for them for a particular disease state. If they’d become educated with their plan, then they won’t have the shock when they come to the pharmacy and wonder why their co-payment is what it is and I think the frustrating thing for us in the profession is that we don’t have an idea what your co-payment is when you come in. We fill your prescription. It transmits to the insurance care. They tell us what to charge of at the counter. They don’t give us an explanation as to why it’s a $30.00 co-payment rather than a $5.00. so that when you go to the counter and you tell the patient that its going to be a $30.00 co-payment and they assumed that its going to be a $5.00, that’s where you get into the confusion and that’s where the patient then doesn’t even realize that there is such a thing as a formulary and how to get it.
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