Consumer Reports has some advice on how to get medicine for an affordable price when insurance drops a pharmacy from its network or it simply does not cover the drug prescribed.
Candida Vazquez needed a refill of her blood pressure medication, but she learned her pharmacy was dropped from her insurance network when she went to pick up her prescription.
"I told the pharmacy when I called them that my blood pressure was high, both because I didn't have my medication and for their audacity to put me through such back and forth," Vazquez said.
Most health plans including Medicare Part D, the prescription drug portion, encourage members to use a specific network of pharmacies. If consumers do not use those pharmacies, they might have to pay significantly more.
Another increasingly common problem is that consumers' medicine is no longer covered by insurance.
"List of drugs that insurers cover are actually decided by middleman companies called pharmacy benefit managers, that when they negotiate deals with drug companies, they may change or even exclude certain medicines from their coverage," said Lisa Gill, Consumer Reports Investigative Editor.
Some drug exclusions can actually save consumers money such as when low cost, generic versions of an expensive name-brand drug becomes available.
"Your first step is to check with your pharmacy and make sure that all of your insurance information has been entered correctly into their system. There may be some glitch that is stopping the insurance company from covering the drug properly," Gill said.
Consumers can also ask pharmacists what the lowest cash price they can offer. Independent pharmacies in particular have more leeway than bigger chain pharmacies to negotiate.
All Consumer Reports material Copyright 2020 Consumer Reports, Inc. ALL RIGHTS RESERVED. Consumer Reports is a not-for-profit organization which accepts no advertising. It has no commercial relationship with any advertiser or sponsor on this site. For more information visit consumerreports.org.