Auto Insurance: Filling Prescriptions

In the US, health insurance plans can help pay for certain prescription medications. However, if you are uninsured or underinsured, you can still fill your prescriptions at any pharmacy and pay in cash or use a discount drug card to reduce costs. It is worth noting that you do not need to use your insurance every time you fill a prescription. In fact, with high deductibles and copayments, you may end up paying a large portion of the medication costs yourself. Before getting a prescription, it is important to check whether your insurance company covers the medication, as this can significantly impact the price you pay.

Paying for prescriptions without insurance

It is possible to fill a prescription without insurance, but it can be stressful and expensive. There are, however, some strategies to help you save money.

Firstly, you can use a prescription savings platform like RxSaver, which is free to use with or without insurance. RxSaver provides prescription savings coupons for more than 6,000 medications, with savings of up to 80%. You can use the RxSaver tool to search for discounted coupons at nearby pharmacies. You simply enter the name of your medication into the search bar on the website or mobile app, and a list of coupon prices at nearby pharmacies will be generated. You then show the coupon at the pharmacy when you pick up your medication.

Secondly, you can compare drug prices at local pharmacies, as these can vary significantly from pharmacy to pharmacy, even in the same zip code.

Thirdly, you can look for retailer savings programs at large chain drugstores. For example, several large retailers, including pharmacy chains like Walgreens or CVS, offer savings programs for members.

Fourthly, you can opt for generic medications over brand-name versions, as generics are usually significantly lower in price.

Fifthly, you can try contacting the manufacturer of the medication to inquire about any discount or cost-reducing programs they may offer.

Finally, you can apply for state, national, or disease-specific drug assistance programs. For example, national and disease-specific drug assistance programs can help you secure free or low-cost medicines if you are uninsured or cannot afford your medicine. Similarly, several states offer drug assistance programs, some of which are aimed at people who don't qualify for Medicaid.

Using a discount drug card

Discount drug cards are a great way to save money on prescription medications. These cards are especially beneficial for those without insurance or with inadequate prescription coverage. They are typically free to use and can be used at most pharmacies. Here are some tips for using a discount drug card:

• Compare prices: Discount drug cards can offer varying discounts on the same medication. Use websites or mobile apps to compare medication prices at different pharmacies before filling your prescription.
• Consider your insurance: While discount drug cards can provide significant savings, they cannot be used in conjunction with insurance. Evaluate whether using your insurance or the discount card will give you a better price. If you have a high deductible plan or your medication is not covered by your insurance, a discount card may be more cost-effective.
• Be cautious of your personal information: Some card providers may collect and sell your personal information. Read the privacy policy carefully before signing up for a card, and avoid giving out unnecessary details.
• Avoid cards with fees: There are many reputable discount drug cards that are completely free to use. Avoid cards that charge a fee, and never provide your insurance information, Social Security number, or Medicare/Medicaid numbers.
• Shop around: Different cards may offer better discounts on specific medications. Try using different cards to see which one gives you the best price. You can also ask your pharmacist for recommendations.
• Consider the type of organization: Cards offered by non-profit organizations are generally preferable as any money they make goes towards their cause, rather than someone's pocket.
• Be aware of the limitations: Discount drug cards cannot be used for all medications. Check the list of eligible medications for each card before signing up.

Understanding insurance coverage for prescriptions

Prescription drug coverage, or pharmacy insurance, is a significant part of a comprehensive health insurance plan. Understanding prescription drug coverage will help you optimise your benefits and save money at the pharmacy.

How Insurance Covers Prescriptions

There is a wide variation in how health plans cover prescription drugs, and rules can vary from state to state. Here are some common ways that health plans cover prescriptions:

• Copays: This is the set amount that you pay for prescriptions. Copays are typically set in tiers according to the plan's formulary. For example, a plan might charge $10 for Tier 1, $25 for Tier 2, and $50 for Tier 3 drugs, with no deductible or other cost-sharing.
• Coinsurance: You pay a percentage of the prescription cost, and insurance covers the rest. This is typically an 80/20 or 70/30 split, meaning you pay 20% or 30%, and your insurance covers the rest. Many plans with coinsurance require you to pay the full price until you meet your deductible, and then you pay only a percentage of the full cost. Some coinsurance plans only require your percentage until the deductible is met, and then they cover prescriptions at 100%.
• Integrated deductible: This includes both medical and prescription costs. Once the full deductible is met, prescription copays or coinsurance applies. Some plans cover prescriptions without a deductible, meaning that copays and/or coinsurance apply to prescription drugs right away, even if no deductible has been met.
• Prescription deductible: Some health plans have a prescription deductible in addition to the medical deductible. Once the deductible is met, a copay or coinsurance applies, typically set according to the drug tier.

Understanding Formularies and Tiers

A formulary is the list of drugs covered by an insurance plan. Formularies provide guidelines on how the cost of the drug is split between you and the insurer. Formularies usually have "tiers", which are groups of drugs classified according to cost. Your co-payment for a drug is based on which tier it is in.

• Tier 1: These are the least expensive prescription drugs available with the plan, typically limited to generic drugs.
• Tier 2: More expensive generic drugs and brand-name drugs designated as "preferred" are in this tier.
• Tier 3: Non-preferred and expensive brand-name drugs are usually in this tier. These drugs will cost a significant amount out-of-pocket.
• Tier 4: This is the most expensive tier, usually reserved for the highest-priced drugs and drugs that treat rare conditions.

Tips for Filling Prescriptions

• Select a convenient pharmacy: Choose a pharmacy that is close to your home address or a chain drug store. If your pharmacy doesn't have the medication in stock, they can call another location or have the drug delivered. After the first fill at a chain pharmacy, you can get refills at any other location within the same chain.
• Use a mail-order pharmacy: You can select a mail-order pharmacy, but be sure to check if they accept your insurance. Some popular mail-order pharmacies include Amazon Pharmacy, PillPack, and Capsule.
• Reduce the cost of prescription drugs: If you are prescribed a brand-name drug, ask if there is a more affordable generic option. You can also ask your physician for manufacturer coupons or search for them on the medication's website. Additionally, there are many sites that offer discounts for prescriptions, such as GoodRX, SingleCare, and WellRX.

Getting a prescription exception

If your prescription medication is not covered by your insurance, you can request a prescription exception to get it covered. This is a type of coverage determination. You can request a tiering exception or a formulary exception. A tiering exception should be requested to obtain a non-preferred drug at a lower cost, whereas a formulary exception should be requested to obtain a drug that is not included on a plan sponsor's formulary or to waive a utilization management requirement for a formulary drug.

To get an exception, you must submit a supporting statement to the plan sponsor, which can be done verbally or in writing. For a tiering exception, the statement must indicate that the preferred drug would not be as effective as the requested drug or would have adverse effects. For a formulary exception, the statement must indicate that the non-formulary drug is necessary because all covered drugs would not be as effective or would have adverse effects, or that the number of doses under a dose restriction has been or is likely to be less effective.

Once the plan sponsor receives the supporting statement, they must provide written notice of their decision within 24 hours for expedited requests or 72 hours for standard requests. If the request is urgent, the insurer must respond within one day. If you don't hear back within the time period, the request is automatically approved. If the request is approved, your insurer must tell you the cost-sharing amount.

If your request for an exception is denied, you can appeal the decision and have it reviewed by an independent third party. If you win your appeal, your insurer must cover the non-formulary drug and continue coverage for the duration of the prescription.

Using a mail-order pharmacy

There are several popular mail-order pharmacies to choose from, including Amazon Pharmacy, PillPack, and Capsule, and GoodRx Gold. Many of these services allow you to sign up online and have your medications mailed in secure, tamper-resistant, and discreet packaging.

To sign up for mail order, you can send in your insurer's mail-order form with your prescription, or have your healthcare provider phone or fax it in. You can then submit refills online, over the phone, or through a mobile app.

It's important to note that mail-order pharmacies operate through your insurer's pharmacy benefit manager (PBM), so using a service that doesn't have an agreement with your insurer's PBM may result in a lack of coverage from your health plan. Additionally, mail-order pharmacies often deliver a 90-day supply of medications, so you'll need to obtain a new prescription from your doctor specifying this duration.

Before signing up, it's advisable to compare the charges of your insurer's mail-order pharmacy, including shipping costs, with the prices of your local pharmacy. Many insurance companies now offer 90-day fills at local pharmacies for similar prices to mail-order services.

Furthermore, consider the timing of your prescription needs. Since mail-order pharmacies typically deliver a 90-day supply of medications, they may not be suitable if you require immediate or short-term prescriptions.

Mail-order pharmacies offer the convenience of home delivery and potential cost savings, but they also come with considerations like potential delays, auto-renewal without confirmation, and the possibility of lost or stolen packages.

Frequently asked questions