One of the last places you want to be surprised is at the pharmacy counter. But plenty of people get a shock when they find out that their insurance company has dropped the pharmacy from its network or that insurance no longer covers the drug their doctor prescribed. It happens more often than you think. Consumer Reports has some advice on how to get the medicine you need at an affordable price.
The list of drugs that insurers cover is actually decided by middlemen companies, called pharmacy benefit managers, that negotiate deals with drug companies and may change or even exclude certain medicines from coverage.
But some drug exclusions can actually save you money. That can happen when, for example, a low-cost generic version of an expensive name-brand drug becomes available.
Your first step should be to check with your pharmacy and make sure all of your information has been entered correctly into its system. There may be a glitch that’s stopping the insurance company from covering the drug you need.
You can also ask the pharmacist for the lowest cash price he or she can offer. Independent pharmacies in particular have more leeway than bigger chain pharmacies to negotiate.
Another tip? About a quarter of plans require consumers to fill certain prescriptions through mail-order pharmacies. If your drug suddenly goes up in price or is no longer covered, check to see whether coverage would be better through mail order.