Welcome to the new year of 2018! It’s a time for New Year’s resolutions, flu season, and the ever changing healthcare system. As the new year begins, remember, your insurance may have made changes to things such insurance cards, policies, and copays. Here is some information when presenting to the pharmacy for prescriptions.
Insurance cards:
Most insurance cards include the billing information that is needed to process a prescription. Along with an ID number, the card will usually have a box on the front of the card that will include information such as a RxBIN, RxPCN, and RxGRP. All of this is needed to bill the insurance to receive a copay for medications, which should be outlined in your yearly benefits package. Some insurance companies have chosen to include the pharmacy billing information on separate prescription coverage cards. If you do not have this information on your current health insurance card, you may want to contact your company to obtain the prescription benefits card.
2018 is a big year for Medicare Part A & B. This is because new Medicare cards (the Red, White, and Blue card) is changing for everyone! You should be receiving a new card with a new ID number in early 2018.
Policies:
Has your pharmacy required a prior authorization from a doctor on a medication you’ve had filled multiple times the previous year? This often happens because policies change every year for many insurance companies. Policies should be outlined in your explanation of benefits package. In these situations, it’s important to be patient. Most of the time, the process is as simple as a few phone calls and paperwork that is completed in a couple days for an approval that lasts a year. Some situations may require a change in a medication that provides the same treatment at a more affordable price.
Copays:
Copays can be confusing. Why? Many insurance plans have different levels of coverage. If your plan states that you have a deductible to be met, before initial coverage begins, you may have to cover up to 100% of the drug cost. I always encourage my patients to consult either the benefits package or the pharmacy customer service phone line on the back of your prescription card. Either resource will have the answers to the questions of copays, deductibles, and coverage levels.
Knowledge is Power! The more you know about your health care, the more you are able to take control of expected, or unexpected, situations that may present this year.
“Be at war with your vices, at peace with your neighbors, and let every new year find you a better man.”