Question: I got my medication back, but my insurance didn’t cover it. What should I do?
Answer: When picking up medications at the pharmacy, it is important to remember that your drug insurance does not automatically cover everything. Some drugs may not be listed on your coverage form. The formulary is the defined list of drugs that the insurance company will include in its coverage. Each company and each plan has its own formulary (list of covered drugs).
There are also types of medications that are not covered by many Medicare Part D insurance products. Some examples of these types of medications are allergy medications, vitamins, over-the-counter medications, aspirin 81 mg, stool softeners, shampoos, toothpastes, cold medicine, hair growth, acne, weight loss and weight gain, and many more. This list of excluded drugs (which is merely an example of some of the drugs not included) does not have to be carried by Part D plans (prescription drug plans – PDPs) or as part of a Medicare Advantage plan . But you may find that some plans include these drugs as an added benefit for you, even though insurance companies aren’t required to include them on their formulary.
Some of these excluded drugs may have been covered under your previous employer’s plan or your Marketplace plan. Each type of insurance has its own rules regarding the inclusions and exclusions of the form.
By purchasing these types of drugs, you may now have to pay full drug prices, or perhaps you can find another way to cover them. There are two commonly used tools to get these drugs cheaply, one is GoodRx and the other is Cost Plus Drug Company. Both of these options are NOT prescription drug insurance products, but simply companies whose goal is to save everyone money on the cost of their medications.
Using these companies to obtain your medications would not replace your insurance, but would be in addition to your insurance coverage under Medicare Part D rules.
To learn more about GoodRx, you can use the goodrx.com website or call 855-268-2822. To learn more about Cost Plus Drug Company, visit costplusdrugs.com. These two companies have different business models.
GoodRx is a discount card that you use at your local pharmacy. You may find that alternative pharmacies give you better prices, so you can switch pharmacies using GoodRx as long as your doctor sends your prescriptions to the new pharmacy.
The Cost Plus Drug Company is a mail-order business. You create an account on their website. Your doctor will need to send your prescriptions to their website, and then you can fill your medications by mail. You will pay a cost for the drug which includes manufacturing cost + 15% markup + $3.00 (pharmacy labor) + $5.00 shipping (additional charge for expedited shipping). You and your doctor decide how many tablets to fill and for how long. You are not limited to a 30 or 90 day supply.
You cannot use your insurance to help pay for these prescription drug costs when using one of these companies. These are alternative prescription drug services that will fill your medications outside of your insurance coverage and formulary. Using these discounted drug options may cost less than your insurance-covered drugs at your local pharmacy.
There are also medications that you can decide to buy over-the-counter because they are cheaper than buying them with a prescription. I often see it with 81 mg of aspirin, allergy medications, folic acid and many more.
Many of these classes of drugs are relatively inexpensive, but the money saved is money you keep. Good luck and hope you save some money.
Senior Life Matters is a community program sponsored by Lutheran Jamestown. For questions or concerns or to reach Janell Sluga, GCMC, call 716-720-9797 or email [email protected]