Filling Your Prescriptions (Non-Medicare)
This article provides educational information about getting your prescriptions filled. Contact your insurance carrier if you're having issues getting your prescriptions filled.
Helpful Terms
Formulary--A list of prescription drugs covered by a plan offering prescription drug benefits. Also called a drug list.
Step therapy--A type of prior authorization. In most cases, you must first try a certain, less expensive drug on the health plan’s formulary that’s been proven effective for most people with your condition before you can move up a “step” to a more expensive drug.
Quantity limits--For safety and cost reasons, plans may limit the amount of prescription drugs they cover over a certain period of time.
Prescription Refill Issues
There are many reasons your pharmacy may be unable to fill a prescription for you under your health plan:
Your new plan is still processing
You haven't met step therapy requirements
You exceeded quantity limit restrictions
There’s a prior authorization or pre-certification for the prescription
Formulary changes occurred
You're using an out-of-network pharmacy
Your coverage lapsed
Prior Authorization
Before filling a prescription, a health plan may require a prior authorization (also known as a pre-certification) to make sure certain prescription drugs are used correctly and only when medically necessary. Before your health plan covers a certain drug, you must meet certain criteria for that particular drug.
Your insurance carrier can tell you what’s needed before filling your prescription. The phone number to contact your carrier is generally on the back of your Insurance ID card.
If you're currently unable to fill a prescription due to a prior authorization or pre-certification requirement, your physician may be able to request an exception from your insurance carrier.
In-Network Pharmacies
The most cost-effective way to fill your prescriptions is to use a preferred, in-network pharmacy (retail or mail order). Standard, in-network pharmacies are available, but you may have a higher copay or coinsurance amount than at a preferred pharmacy. If you use an out-of-network pharmacy, you may have a higher out-of-pocket cost. In some cases, you may have to pay the retail cost and submit a claim for reimbursement from the carrier.
The licensed benefit advisor* you speak with during your enrollment call can tell you which pharmacies are in-network for the health plans you’re considering.
If you’re already enrolled in a health plan, contact your insurance carrier or visit its website for a list of preferred and standard, in-network pharmacies (retail and mail order). The insurance carrier's phone number is generally located on the back of your Insurance ID card.
*Our licensed benefit advisors specialize in health insurance for retirees. They go through annual training and certification to ensure they can help you make an informed and confident decision.
Additional Assistance
Contact the carrier of your prescription drug plan for information on filling your prescriptions using mail order. The phone number to contact your carrier is generally on the back of your Insurance ID card.
Please call us at 1-866-322-2824 for assistance if you’re having trouble reaching your carrier or need additional assistance.
