Prescription refill question and changing insurance

[Pembo]

Seems like I should know this answer please help
DH is changing jobs and so insurance will be changing. Current prescription is through mail order pharmacy, Express Scripts and has 3 refills left.
Not sure of new insurance and prescription policies. Only use mail order because I have to.

When our insurance changes, how do I get my refills? Do I call them and give them new insurance info?

Like I said, this seems like it should be obvious but I'm clueless~ Never had to change insurance before.

 

[disprincessatheart]

Once you get new insurance, you'll need to find out if they use mail order or not - some dont. Get anything you can refilled before the current insurance expires so you have some on hand, and then for anything that you might need again soon, get your doctor to call in a scrip to a local pharmacy. Even if the new employer uses a mail order system, you normally don't have to start using it until the 3rd fill of each prescription.

 

[clh2]

My insurance is very specific about what is and is not covered with prescriptions that are covered in and out of network. You may want to check where your new policy covers prescriptions and then get yours

Obviously every insurance plan is different!

 

[DebbieB]

If your new company does not use Express Scripts, then I would contact the new company and ask them if they can have it transferred. You can do that with retail pharmacies, I imagine that mail order could do the same. Or your doctor may have to send a new one.

 

[lsyorke]

Mail order pharmacies will transfer scripts.

 

[Micca]

Pembo I went through this recently and it was a big pain in the neck. When my ins. policy changed, the mail order provider changed from another company to Express Scripts. There was a hassle with Express scripts and my doctors offices. I don't have any specific suggestions except to be sure you have enough of your meds on hand such that if the changeover process takes 2-3 weeks, you won't run out.

It really was a comedy of errors. One example: Told a doctor I had a new mail order pharm provider so he promptly called my FORMER provider for refills. Of course they were going to refill the scripts--at full cost because I was no longer covered It was one stupid thing after another, so please be careful and stay on it! Good luck

 

[ariel71]

There are going to be several things you'll have to know about your new plan before you can figure out the correct approach. Understand if the policy has in/out of network providers. Know your coverage and copays. If it's brand-specific, you'll need to see if it's covered on your formulary. One of my prescriptions was extremely frustrating because certain dosages were only covered for a specific number of pills and/or days. The plan will tell you your options for retail or mail-order.

Honestly, I would just get one last refill before you switch and then ask the doctor for a new script. There may be things he can tweak that are more aligned with the specifics of the new plan. He may even have to change it altogether based on the new coverage.

 

[The Mystery Machine]

Just make sure you can get as many refills as allowed before the switch.

After that a call to the new insurance carrier will direct you with what you are able to do with regards to prescription coverage.

For starters, you might have to get new doctors. Hopefully not, but if you do, make sure you make appts. right away to establish yourself as a patient and then get your records transferred so you can get working on your script transfers. This will take time so do not delay 1 second if you have to make a doctor switch.

If you do not have to switch doctors then you must be diligent with your script coverage with making sure THEY BILL the correct insurance. That means a lot of double checking, having them repeat orders, who they are billing, etc. Never assume that they are going to get it "right". Do this for awhile until you are confident that things are going smoothly.

 

[Pembo]

Thx everyone. Looks like I'm in for a lot of phone calls in the future. Nothing is ever easy is it?!

 

[ariel71]

Just make sure you can get as many refills as allowed before the switch.

After that a call to the new insurance carrier will direct you with what you are able to do with regards to prescription coverage.

For starters, you might have to get new doctors. Hopefully not, but if you do, make sure you make appts. right away to establish yourself as a patient and then get your records transferred so you can get working on your script transfers. This will take time so do not delay 1 second if you have to make a doctor switch.

If you do not have to switch doctors then you must be diligent with your script coverage with making sure THEY BILL the correct insurance. That means a lot of double checking, having them repeat orders, who they are billing, etc. Never assume that they are going to get it "right". Do this for awhile until you are confident that things are going smoothly.

But why even bother with this when it would be so much easier to just get a new script before the switch and not deal with a transfer? Yes, OP may have to get a new doctor for her medical plan. But I've never seen a medication plan that doesn't honor prescriptions from any licensed physician. So if her plan changes 1/1/14, get the refill in December, call the current doctor, say you're switching plans in January and ask if you can have a new script to cover what would have been refills so you don't have any problems with transferring the old prescription. Chances are any new plan will allow you to use a retail pharmacy until a certain number of refills. Take the new script and the new prescription card to the pharmacy (in network, if required), get the fill, done.

The most important thing is to make sure the actual script (dosage, time period, brand name/generic) is covered under the new plan. That would matter whether its a refill or not. That might be even more of a reason to get a new script - the doctor may need to change it to make sure it's covered and/or makes the most sense economically. Review the terms of the new plan for medication pricing. Sometimes paying out-of-pocket can be remarkably cheaper. There was a recent thread on this.