Why Your Prescription Is Not Covered By Insurance
It's a terrible feeling when you leave the doctor's office with a new prescription, only to find out that your insurance provider isn't going to cover your prescription. This can happen to all people with prescription coverage such as Medicare, Medicaid, and Private Insurance.
Here's why:
Health insurance companies have a Formulary, which is essentially a list of medications that they have decided are both therapeutically effective and cost-effective. If they were to cover every medication in existence, chances are they will go bankrupt. They employ healthcare professionals like Pharmacists, to evaluate studies and data on the effectiveness of certain drugs and to determine whether or not they are worth including in their Formulary.
If your local Pharmacist tells you that the insurance says the drug is Non-Formulary, chances are your prescribed medication has a cheaper alternative that is just as effective for you. You can have your pharmacist call your doctor (if their office is opened), to get approval to change to a different medication. Otherwise, if the pharmacy is busy, you can call your doctor's office yourself to let your doctor know what happened and give him or her the pharmacy contact information.
If your local Pharmacist tells you that Prior Authorization is needed, that means the health insurance has decided that the prescribed medication requires your doctor to fill out and fax over paperwork as to why you must take that medication instead of using a cheaper alternative that could be just as effective. If this is the case, the pharmacy can call your doctor's office to inform him or her of the Prior Authorization message to decide whether the doctor will reach out to your insurance or change to a cheaper alternative.
**It is best to go to your pharmacy as early as possible before your doctor's office is closed so your pharmacy can address these prescription issues with your doctor.
Here's why:
Health insurance companies have a Formulary, which is essentially a list of medications that they have decided are both therapeutically effective and cost-effective. If they were to cover every medication in existence, chances are they will go bankrupt. They employ healthcare professionals like Pharmacists, to evaluate studies and data on the effectiveness of certain drugs and to determine whether or not they are worth including in their Formulary.
If your local Pharmacist tells you that the insurance says the drug is Non-Formulary, chances are your prescribed medication has a cheaper alternative that is just as effective for you. You can have your pharmacist call your doctor (if their office is opened), to get approval to change to a different medication. Otherwise, if the pharmacy is busy, you can call your doctor's office yourself to let your doctor know what happened and give him or her the pharmacy contact information.
If your local Pharmacist tells you that Prior Authorization is needed, that means the health insurance has decided that the prescribed medication requires your doctor to fill out and fax over paperwork as to why you must take that medication instead of using a cheaper alternative that could be just as effective. If this is the case, the pharmacy can call your doctor's office to inform him or her of the Prior Authorization message to decide whether the doctor will reach out to your insurance or change to a cheaper alternative.
**It is best to go to your pharmacy as early as possible before your doctor's office is closed so your pharmacy can address these prescription issues with your doctor.