What You Should Know

            In working our day to day jobs, we become very familiar with every aspect of those job. We come to know all of the ins and outs, what makes things run smoothly, and what can throw off an operation in an instance. And in this familiarity, we can forget the laypersons understanding of our service and problems can arise. We have all had the encounters where we wonder: doesn’t this person know how this is supposed to work? But maybe they don’t. Perhaps, this is the first time this person has ever had to utilize this service. Or maybe they’ve been making the exact same mistake for the past five years and no one has bothered to teach them otherwise. What we often fail to realize is that the things that have become so familiar to us, were not inherently that way. Thus, I have compiled a list pertaining to my career field of pharmacy of things that might benefit you to know.

Pharmacists are typically doctor level trained professionals. They know a lot more about healthcare than just what the drugs do.

Pharmacists are specifically trained in recommending over the counter medications. The next time you feel overwhelmed by the shelves upon shelves of cough and cold products, ask for a recommendation based upon your specific symptoms, other health conditions, and concurrent medications you are taking. You will get a much better, more individualized recommendation than your coworker who says: Nyquil always works for me.

Pharmacies are busy. The next time you ask what is taking so long with your medication, keep in mind that pharmacies can fill upwards of 800 prescriptions a day, and every one of those people inevitably think their orders should be top priority.

Pharmacists typically want you to get your medication, save for inappropriate orders for drugs of abuse. It is good for your health. It is good for their metrics, or if they have a stake in the pharmacy, their profits. It is the essence of their business, so they have every incentive to get you your medications. But, they have to be compliant with the DEA, the board of pharmacy, the policies of whatever company they work for, and someone has to pay for the medication. With the current insanity that is drug pricing in the U.S., if your insurance isn’t paying for it, there’s a very good chance you cannot afford it.

Medications are very expensive. If you are insured, you might not realize just how expensive. Every pharmacist has had some variation of this dialogue:

“I’m afraid your insurance doesn’t cover this product.”

“Well I’ll just pay for it then, how much is it?”

“For a 30 day supply it would be $1,399.”

Luckily, your pharmacist is also an expert at third party claims adjudication and can recommend an alternative to your physician that is both cost effective and therapeutically equivalent.

Lastly, the number one thing I wish people knew about pharmacy. What are those prescription discount cards I keep getting in the mail? It says I can save up to 80%. Prescription discount cards are alternatives to billing a prescription drug to your insurance. Typically, they help reduce costs for the uninsured, although occasionally they can offer lower prices than your prescription drug benefits. Here is what you need to know.

You cannot bill both the discount program and your insurance for the same medication, it is one or the other.

Claims to the discount program do not apply to insurance benchmarks such as meeting your deductible or out of pocket maximum.

The copay for a covered product will almost always be less billed through your insurance e.g. a drug that costs $80 will probably have a $10 copay if billed through commercial insurance but cost around $40 with a discount program.

It is not a coupon. Even checking the price for a card requires the initial claim to be reversed, the new claim to be processed through the discount program, and if the price is higher, as I just mentioned it probably will be, you then have to reverse the new claim and rebill the insurance company, then re-ring the entire sale. All, essentially, for nothing. These cards are great options for the uninsured, however, if you have prescription drug coverage they are not likely to save you much. If you have medication that is already very expensive through your insurance it may be worth a try, however, if this is a chronic medication, using a therapeutic alternative that is covered by your insurance is likely a much more sustainable option. Luckily, your pharmacist can make such recommendations if you ask.

I hope this helps you the next time you visit the pharmacy.

-AMS