Prescription Drug Benefits and your new 2014 health plan

If you enrolled for a new health plan for 2014 you probably don’t have new ID cards yet.  And, if you’re taking medication, you may be needing to get a refill or a new prescription soon.  What do you do if you don’t have your new ID number?

1.  If you purchased a Covered CA plan with Blue Shield of California, we’ve been told that Walgreens will fill your prescription if you give them your full name, Date of Birth and Social Security Number. 

2.  If you purchased coverage through your existing carrier, you will likely have the SAME ID number that you had before.  You can try refilling your prescription at your existing pharmacy using this number.  However, be aware that some of the OTHER ID numbers may have changed.  So even if your ID number is the same, your new policy numbers for prescription medication may not be loaded in the system yet.  If this happens, you should:

  • Ask your pharmacist to call your health plan to verify coverage
  • Ask your pharmacist to give you a small supply of your medication (if you are completely out) to allow for a few days time.  Then, go back to the pharmacy and ask them to re-run the prescription and refill the remainder of the medication.
  • Pay for the full cost of your medication, but return to the pharmacy within 3 days and ask them to re-run the prescription.  Most pharmacies will do this within a 3 day period and refund you all but your required costs under your plan.  If they won’t re-run the prescription, or if you don’t make it back there within the 3 day time frame, you can submit a paper claim for the prescription so that the health plan an reimburse you or add the cost you paid toward your deductible. 

3.  If you purchased new coverage with a new carrier, you will probably have to wait until you get an ID number to get your prescription paid for.  You can follow the steps outlined above.  Have your pharmacy use your name, Date of Birth and Social Security Number to identify you to the health plan.  If they can’t find you in the system, you may need to pay for the full cost of your medication and file a claim later on. 

4.  If you call your health plan to get your ID number, you should also ask for the following numbers:  BIN#; PCN#; Group #.  Even if you purchased an individual policy, each policy has a Group number.  These ID numbers identify exactly which health plan and prescription plan you have.  Your pharmacy will need these if they cannot find you in the system.   (Updated 1-14-14)

Please keep in mind that doctors and pharmacies are now experiencing a massive influx of patients with new coverage.  They are inundated with patients and they can’t get through to the health plans to get answers.  Everyone is frazzled and tempers are short.  If we all remember this, sympathize,  and understand that we’re all in the same boat, it will be easier to get through it.

If you are taking a high cost medication, experimental medication or a prescription that requires prior authorization, you may need to work with your doctor and new health plan to get any necessary authorizations. This may take additional time.

If you require a life sustaining medication, your pharmacy should be willing to help you obtain required information and authorizations from your health plan.   If you are in this situation, and cannot get help, please contact us for assistance.

 

January 14th, 2014 by RealCare Insurance Marketing, Inc.