Prescription Insurance: Switching To Save

Changing prescription insurance can be a confusing process, and there are several factors to consider. Firstly, it's important to understand the specific policies and procedures of both your current and new insurance providers. This includes knowing whether they offer mail-order or local pharmacy services and whether they have specific pharmacies that they work with. You should also find out whether your new insurance covers your current prescriptions and whether there are any changes you need to make to your prescriptions to align with the new plan. It's also crucial to ensure that you have enough medication on hand to cover the transition period, as changing insurance can sometimes take a few weeks.

How to handle mailed prescription drugs after changing insurance

When you change your insurance, you may have to change your mail-order prescription company. Your new insurance company will send you a packet of information, which will include instructions on how to handle your mail-order prescriptions. If you can't find this information, look at your insurance card, which will have a list of numbers to call for different concerns. One of them will be for prescription drug queries.

You will need to talk to your doctor's office staff and show them your new insurance card. Once they have your new prescription drug coverage in their system, they can inform the company about your prescriptions and begin the process of getting your medications mailed to you.

After your doctor sends your prescriptions to the mail-order company, you will need to call the company and tell them to fill these prescriptions. You will also need to give them your correct information, including your name, date of birth, ID number, contact information, and address. Once you confirm that you want the medications, they will fill your prescriptions and mail them to your address. The refill information will come with your medications, and you can usually refill your prescriptions online or over the phone. This process may require that you give them credit card information to bill your medication.

You may choose to use both mail-order and local pharmacy services. You can get some medications from the local pharmacy and some from mail order, depending on what works best for you. Just be sure to let your pharmacist know that your insurance coverage has changed.

What to do if your prescription refill is due when your insurance changes

If your prescription refill is due when your insurance changes, there are a few things you can do to ensure you receive your medication without interruption. Here are some detailed steps to follow:

Before your insurance changes:

• Check with your current insurance provider to see if you can get any remaining refills approved before the change. This way, you will have some extra supply on hand in case of any delays with the new insurance.
• Contact your doctor's office and inform them of the upcoming insurance change. Provide them with the details of your new insurance plan, including the prescription drug coverage information.
• If you use a mail-order pharmacy, find out if this service is compatible with your new insurance. If not, you may need to switch to a local pharmacy or one that is in-network with your new insurance. Contact your new insurance company to understand their specific procedures for mail-order or in-network pharmacies.
• If you are unable to use a mail-order pharmacy with your new insurance, ask your doctor to call in a new prescription to a local pharmacy.
• If you have any remaining refills with your current insurance, get them approved before the change, especially if it is a medication you rely on daily.

After your insurance changes:

• Show your new insurance card to your local pharmacy, so they know which insurance to bill your medications through.
• Contact your new insurance company to understand their specific procedures for prescription refills, including any restrictions or limitations.
• If your prescription is no longer covered by your new insurance, you may still be able to purchase the medication at a higher rate or out-of-pocket cost. Contact your insurance company to understand your options.
• If your pharmacy says your new insurance no longer covers your prescription, discuss next steps with your doctor or insurance provider. You may need to follow an exceptions process or file an appeal.
• If you are unable to get your prescription filled through your new insurance, consider using a service like GoodRx to find coupons and discounts for your medication.

Remember, it is essential to plan ahead and stay on top of your prescription refills to avoid any interruptions in your medication supply. By following these steps, you can help ensure a smooth transition when your insurance changes.

How to find a new in-network pharmacy

When changing prescription insurance, you may need to find a new in-network pharmacy. An in-network pharmacy is a pharmacy with an agreement with your insurance provider to provide prescription drug coverage. Using an in-network pharmacy is essential to have your prescription drugs covered by your insurance.

There are several ways to find an in-network pharmacy near you:

• Check your insurance provider's website — Many insurance providers have a provider directory on their website, which includes information on in-network pharmacies.
• Contact your insurance company — You can call the customer service number on the back of your insurance card or insurance ID card to speak to a representative and ask for a list of in-network pharmacies in your area.
• Use an online pharmacy search tool — Some insurance companies offer online tools or apps that allow you to search for in-network pharmacies based on your location. You may need to log in to your member account to access this information accurately.
• Check with your employer — If your insurance is provided through your employer, you can contact your company's human resources department to inquire about in-network pharmacies.
• Ask your doctor or current pharmacy — Your doctor's office or your current pharmacy may have information about which pharmacies are in-network with your insurance plan.

Once you have found a new in-network pharmacy, you can switch your prescription by providing your new pharmacy with your prescription information and new insurance details. The new pharmacy can then coordinate with your previous pharmacy to transfer your prescription.

How to understand your new prescription coverage

Understanding your new prescription coverage can be tricky, but it's important to know what you're entitled to and what you need to pay for. Here is a step-by-step guide to help you understand your new prescription coverage:

Check the Formulary

Firstly, you need to check the list of drugs covered by your plan. This is called the 'formulary'. Each health insurance plan has one, and it outlines the prescription medications that are covered and how much they will cost you. You can usually find this on your insurer's website or by calling them and asking for a copy. If you are already a member, you can log in to your account to find this information.

Understand the Tiers

The formulary will be divided into 'tiers', which are groups of drugs classified by cost. The higher the tier number, the more you will pay out of pocket. Here is a general overview of how tiers are typically structured:

• Tier 1: Least expensive, usually generic drugs.
• Tier 2: More expensive generics and preferred brand-name drugs.
• Tier 3: Non-preferred and expensive brand-name drugs.
• Tier 4: Most expensive, usually for rare conditions.

Compare Costs

Now you know which drugs are covered and how they are tiered, you can compare the costs. Check if your prescriptions will be covered by a simple copayment, or if you need to meet an annual deductible first. If you need to meet a deductible, you will have to pay out-of-pocket until you reach the threshold.

Check for Exclusions and Exceptions

Some drugs may be excluded from your plan, meaning they are not covered at all. If a medication you need is not covered, you can ask your insurance company about making an exception. You can also ask your doctor about alternative medications that are covered by your insurance.

Understand the Process

If you need to request an exception, find out the process from your insurance provider. This may involve filling out a form, and you may need input from your doctor. There will be a timeline for reviewing your request, and if it is denied, you can appeal the decision.

Keep Up to Date

Formularies and costs can change, so make sure you keep up to date with any changes to your prescription coverage. This will help you avoid unexpected costs and ensure you are getting the best value from your plan.

How to transfer your prescription to a new pharmacy

Transferring your prescription to a new pharmacy can be done in a few simple steps. Here is a guide on how to transfer your prescription to a new pharmacy:

Check that your prescriptions are offered at the new pharmacy:

First, ensure that the new pharmacy offers your prescription. Talk to your pharmacist to confirm that they will accept the transfer of your prescription, as pharmacists can legally refuse. Additionally, certain medications, such as Adderall, Concerta, and Oxycontin, cannot be transferred to a different pharmacy. There are also medications that can only be transferred once, even if you have more than one refill left, such as Ambien, testosterone, Ultram, and Xanax.

Inform your doctor:

Once you decide to switch to a new pharmacy, let your doctor know to avoid any confusion with future refills or updates to your current prescriptions.

Prepare your prescription information:

Before contacting your new pharmacy, gather a list of your prescription information, including the drug name, strength, and prescription number, your medical history, a list of current prescriptions, personal information, and insurance information.

Contact your new pharmacy:

Get in touch with your new pharmacy by calling, stopping by in person, or going online if they offer transfer services on their website or mobile app. Provide them with the name, strength, and prescription number of each medication, along with the phone number and address of your previous pharmacy. If you are transferring within the same pharmacy company, such as CVS or Walgreens, the process is often more streamlined and may only require your name and date of birth.

Submit your health and insurance information:

Provide your new pharmacy with your health and insurance information, including any prescription insurance and coupon information. This can usually be done online through their website if they offer online transfer services.

Wait for the transfer to be completed:

Give the pharmacies sufficient time, usually about 2-3 days, to complete the transfer process. You can also ask your pharmacy team how long they expect the transfer to take, given their current workload and staffing. If you want to be notified when your prescription is ready, provide your preferred phone number, and sign up for text alert services if they are offered.

Pick up your prescription:

Remember to bring your insurance card and any coupons you want to use when picking up your prescription. It is best to give this information as early in the process as possible to avoid delays.

Additional considerations:

• If your prescription has run out of refills, your new pharmacy may be able to contact your healthcare provider on your behalf to request a new prescription. However, some pharmacies are not allowed to send refill requests if you haven't filled a prescription with them before.
• It is important to inform your new pharmacist of all medications and supplements you take, including over-the-counter medicines, to ensure your safety and avoid potential drug interactions.
• Be aware that certain prescriptions, such as Schedule III, IV, and V medications, are classified as controlled substances and can only be transferred once. Schedule II controlled substances, such as Adderall, Ritalin, and OxyContin, cannot be transferred at all and require a new prescription each time.

By following these steps, you can easily transfer your prescription to a new pharmacy and take advantage of benefits such as better pricing, a more convenient location, or improved services.

Frequently asked questions