There is nothing more difficult when filling a prescription than having an insurance problem arise. It is uncertain to be told that your medication is not covered by your insurance, and it is often difficult to understand why this becomes a problem.
The first step to getting your insurance coverage right is to know the actual situation. There are several reasons why a insurance company may deny you coverage for a particular drug or prescription.
a. Prior permission.
Essentially, your prior authorization is the insurance company’s way of keeping costs down by making sure your doctor has tried the least expensive treatment first, or medication may not be on the insurance list of drugs they prefer (often called “formula”. ). If this happens, ask the pharmacist or technician to contact your doctor for “preferred therapy.” Your doctor will be able to authorize the pharmacy to use another medicine instead of the prescribed one over the phone.
c. They are excluded from the drug class.
This is especially a problem for dissuading drugstores who are usually left with few options. This means that your insurance company does not cover the particular drug that you are trying to fill, nor does it cover any drug used for the same.
Common medications that may be denied drug coverage class exclusions include: male enhancement medications (ie – Viagra, Levitra, or Cialis ), drug therapy (i.e. – Retin-A Micro, Vaniq), camentum drugs (i.e. – Propecia) and drugs plus-contra (Prilosec, Colace, Benadryl).
d. Fill up too quickly.
If we ask a pharmacy to fill a prescription when your insurance company has already used a supply for days, be assured that your refill is fast. There are many reasons for this, and many results.
If the refill is too soon because you have taken more medicine under the direction of your doctor, your pharmacy can contact your insurance company for a “change of treatment”. Sometimes your insurance company can control it, but not always.
If you have taken more medicine than you should, especially if it is a medicine or a medicine that is pain. It’s a potential abuse, your pharmacist will almost certainly refuse you a refill, even if you offer to give her cash. That is your health and safety.
If you go on a trip or vacation, it is at the discretion of your insurance provider whether or not they will allow you to receive vacation coverage. Ask your pharmacist to meet and speak with a representative at your insurance company.
Now that you understand some of the most common issues with your prescriptions and insurance policies, you’re ready to help resolve your issues quickly and easily.
