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Those of you who are already patients of our practice know that Dr. Roesel is nosy. She will ask about your pets, your sex life, your urination, what good or bad things are going on in your life... and she will ask you if you know about your prescription plan. Why does she do this? Doesn't she have anything better to do?
The fact is, prescription medicines, especially brand name drugs can be very expensive. And if you are do not know the type of coverage for prescriptions that you have, you could be in for an extremely unpleasant surprise at the pharmacy check out counter.
Dr. Roesel is aware of this because several of the medicines she commonly prescribes do not have a generic equivalent available. So she asks because we may have ways to help you get your medicines at a reduced cost. Some drug companies provide money off coupons to help reduce your co-pay. Some even provide coupons for a free month's supply of the medicine. And there are some programs that will provide you with your medicine free of charge if you qualify, usually based on financial need.
With the many confusing options you have when choosing an insurance plan it is hard to figure out what your prescription benefits are. Here are the basics. Most insurance companies have what is called a "formulary". This is a list of drugs that they believe are cost effective and will be covered with certain exceptions. These drugs are then usually classified into "tiers". (For the specifics of your particular plan, you should contact the company directly or visit their website for subscribers.)
Tier one drugs include most generics. These are the medicines that have the lowest co-pay of all. Tier two drugs include brand name drugs and have an intermediate co-pay amount. Tier three drugs are the most expensive and may require prior authorization or have quantity limits.
The difficulty arises when you have a plan that includes the cost of your prescriptions as part of your deductible - that is, you must meet your deductible before your insurance company will pay for your medications. If you have a high deductible plan with no separate prescription plan the cost of brand name medicines may be very high for you until your deductible is met.
There are so many different plans that we cannot possible know them all. So please don't be offended if we ask you to check with your insurance company to find out what a particular medication will cost you. Often you can call your pharmacy that has your insurance information on file and they will tell you.
Dr. Roesel prescribes what she thinks would be the best medication for your specific condition. If it is a new medicine, she will usually give you samples to see if you have any side effects before you actually fill a prescription. If we have coupons we will always offer these to you. Talk to us. Let us know if you can't afford a medicine. We want to help.
And we want to avoid this!
