Prescription drug coverage benefits can be confusing—and can often be a source of added stress for patients who manage chronic conditions or rare diseases. As specialty pharmacists, it’s our job to help patients have a smooth transition to a new benefit year so they don’t miss a dose of their life-changing or life-saving medication.
Nearly half of all adults take steps to manage their prescription benefits before the new year, according to a survey AllianceRx Walgreens Prime conducted in 2018. To help ensure timely delivery of their prescriptions heading into the new year, pharmacists may need to remind patients to review their health plan information, schedule a doctor’s appointment, check on prior authorizations, or refill medications.
There are 7 steps pharmacists can recommend to their patients that can make their prescription experience better and easier:
- Use online tools. Creating an online account is one of the first and easiest steps patients can take to manage their prescriptions. Once online, patients can check to see if they need refills of their medications. They may also be able to opt in to receive email and text reminders, complete online clinical assessments, and report any adverse effects they may be experiencing.
- Ask about prior authorizations. Suggest to patients that they ask their pharmacist now if prior authorizations are required or need updating. If so, patients will need to submit new insurance information to their pharmacy and update their financial assistance or copay information.
- Ask the health plan about medication coverage. Another way patients can plan ahead is by checking with their health plan to determine if their medication coverage will change in the new year. They can also verify their copay costs and contact their health plan with any questions.
- Ask about ways to save. Remind patients to check for potential cost-savings opportunities. For instance, financial assistance programs—ie, manufacturer copay card, foundation or free drug programs—may require re-enrollment for each new calendar year. Also, some health plans may cover prescription drugs even if patients haven’t met their deductible, while other plans may reset the deductible to $0 at the start of the new benefits year. For this reason, suggest that patients double check to see what savings may be available to them.
- Verify the pharmacy of record. We recommend patients verify with their doctor who they have listed as their pharmacy of record and to update it, if necessary. Doing so will help ensure timely refills for patients.
- Ask a doctor about appointments. Recommend to patients to ask their health care provider about prescription refills. Suggest they schedule an appointment now, if required, for new or existing medication. During their appointment, they can discuss any medication concerns with their doctor.
- Talk to their pharmacist. Remind patients that pharmacists are available to answer any questions they may have about their medications, including adverse effects, financial assistance, or additional resources.
By counseling patients to take these simple steps before the start of the new year, pharmacists can help them to continue to receive medications in as timely a manner as possible and, ultimately, stay medication adherent as well.
Tracey James, RPh, is a registered pharmacist and also senior vice president of pharmacy services at AllianceRx Walgreens Prime.
AllianceRx Walgreens Prime Offers Five Tips to Help Patients Get Medication Timelier in the New Year. Orlando, FL: AllianceRx Walgreens Prime; December 5, 2018. https://alliancerxwp.com/files/live/sites/arxweb/files/pdfs/press%20releases/arxwp-offers-tips-for-mangaging-prescriptions-in-new-year-december-2018.pdf. Accessed December 15, 2021.