Myth: Pharmacists are insurance experts

Reality: A select few are experts due mostly to lots of experience with repetition in processing pharmacy claims but the truth is, there are hundreds of different insurance companies each with several different plans and these plans can change all the time.  Each state and employer may have a different plan and each of these insurance plans has a preferred drug list.  The preferred drug list is different for each insurance so if you are taking atorvastatin and then change jobs and get new insurance, the new insurance may have simvastatin as the preferred statin and they won’t pay for atorvastatin now unless you get authorization.  This results in either a pharmacist calling the insurance company or calling the doctor to change the prescription.  Both result in a longer wait time. 

Also, a big note to the general public: most insurance companies’ deductibles start over at the beginning of the calendar year.  So if your medication co-pay was $10 in December and then jumps up in January that is usually why.  Another reason your co-pay may change in January is because just as insurance deductibles start over, the company may have raised the tier prices of your co-pays meaning your once generic co-pay of $10 is now $15.  Again, this usually requires you to contact your employer or insurance company via phone or their company benefits webpage. 

PracticeJoanna Simmon