‘Just What the Doctor Ordered’ is No Longer the Case

Gone are the days when you can take a piece of paper to the local pharmacy and obtain “just what the doctor ordered.”  We now have prior authorizations, quantity limitations, and additional requirements that are designed to limit wasteful pharmacy spending and maximize effective health care.  This may leave consumers feeling overwhelmed and confused.

But it doesn’t have to be that way, and understanding your plan is the first step.  Private health insurance carriers offer a variety of tools and educational materials to ensure you are receiving the proper medication, at the most affordable cost.

In addition, here are three helpful tips.

Consider three-month supplies for maintenance drugs. While not all medications are eligible for a 90-day fill, several maintenance medications are. These types of medications typically are given to members on a regular basis, and the member is expected to take these pills long-term.  Examples of conditions include those associated with thyroid, blood pressure, and cholesterol.  Verify whether your plan allows you to fill a 90-day supply at the cost of a 30 or 60-day supply.

Shop around. Several pharmacies – both chains and mom and pop stores – may carry your medications, but the cost varies. Use the carrier websites and Internet to compare prices. In addition, mobile apps may be able to produce coupons or discounts that help reduce the amount you may for certain medications.

Take action. If your provider recommends that you take a certain prescription, pull out the famous W-questions. Why did you recommend this drug? What are the side effects? What is the generic equivalent? Understanding the full picture, including the physician’s motivation (i.e. safe integration with drugs you are already taking) for prescribing that particular drug will help ensure that you are obtaining the best medication to meet your particular needs.

For a comprehensive overview of your pharmacy coverage and cost containment tools, visit your carrier’s website or contact your insurance representative.

Michigan Planners is a statewide employee benefits agency with more than 50 years of experience.  With offices located in Washington Township and Traverse City, they serve as a long-term strategic partner in the design, implementation and management of employer sponsored benefits.