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Consumer Reports: Getting prescriptions without insurance

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Posted at 8:59 AM, Jan 04, 2021
and last updated 2021-01-04 09:59:09-05

(CONSUMER REPORTS/WTVF)  — One of the last places you want to be surprised is at the pharmacy counter, but it happens from time to time. So, what do you do when you suddenly find out you can't get the medicine you need?

Most health plans -- including Medicare Part D, the prescription drug portion -- encourage members to use a specific network of pharmacies. If you don’t, you might have to pay more -- in some cases, a lot more.

Another increasingly common problem is that your medicine is no longer covered by your insurance.

“The list of drugs that insurers cover is actually decided by middleman companies, called pharmacy benefit managers, that when they negotiate deals with drug companies, may change or even exclude certain medicines from the coverage,” said Lisa Gill, Consumer Reports Investigative Editor.

But some drug exclusions can actually save consumers money, like 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 information has been entered correctly into their system. Three may be some glitch that is stopping the insurance company from covering the drug properly," Gill said.

You can also ask the pharmacist what the lowest cash price he or she can offer is. Independent pharmacies in particular have more leeway than bigger chain pharmacies to negotiate.

Some health plans require you to fill certain prescriptions through mail-order pharmacies. So, if your drug suddenly goes way up in price or you find it's no longer covered, check to see whether you can get it covered through mail order.

And now that we've started a new year, a lot of folks are starting new health plans. This is a good time to review your plan and know exactly what it covers.