You may find that the medicine you’ve taken for years is no longer covered.
It’s that time of year — when a trip to the pharmacy for routine medications could be anything but routine. You may find that the medicine you’ve taken for years is no longer covered if you’ve changed insurance carriers or your current plan has changes that take effect in the new year.
Perhaps your medicine may be covered, but it falls under a more expensive co-pay tier. Or your insurance will pay for it only after you switch to a lower-priced option for a while to see if another drug might work just as well.
“That’s how they work to control costs,” said Kelly McDonald, pharmacist and manager of the new Norton Healthcare Pharmacy at Norton Hospital.
Many insurers send letters alerting customers who may be affected, but it also pays to be proactive. Read the fine print in annual enrollment packages or on your insurer’s website. Often, there is a link to the health plan’s formulary, which is a list of generic and brand name drugs that the plan prefers over more costly alternatives.
“Sometimes a trip to the doctor is necessary when formulary changes require a switch in maintenance medications,” McDonald said. “The formulary’s preferred drug may conflict with something else the patient takes, or lab work may be needed to determine a proper dose.
“Most doctors won’t just change (a prescription) without seeing the patient first,” McDonald said. “It’s also a good time to reassess the patient’s condition.”
Another thing to watch for: Some insurance carriers change pharmacy networks beginning Jan. 1, requiring patients to transfer prescriptions to new pharmacies.
“It’s a very busy time for pharmacies,” McDonald said. “I wouldn’t wait until the last minute or until you’ve got one pill left.”
And don’t let your 2014 insurance cards get lost among the holiday mail. Slide them into your purse or wallet as soon as you receive them. While you’re thinking about it, upload a photo of your insurance cards to that fancy new smartphone, so you’ll never be without them. Also upload a list of what medications you take, so it’s handy in an emergency.
The Norton Healthcare Pharmacy is located on the second floor of Norton Hospital, 200 E. Chestnut St., in downtown Louisville. It is open to the public as well as hospital patients. For more information, call (502) 629-3800.