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It’s December!
Did you get a letter from your insurance / pharmacy benefit manager (PBM) about changing pharmacies?
Are you worried about your deductible resetting January 1?
Here are my tips for navigating med refills for the next 2 months.
1/13
Did you get a letter from your insurance / pharmacy benefit manager (PBM) about changing pharmacies?
Are you worried about your deductible resetting January 1?
Here are my tips for navigating med refills for the next 2 months.
1/13
Stop: Check and see if it’s time or almost time for your refill(s). Call your pharmacy today, rn, if so. It’ll make sense later. 2/13
Okay, first, let’s tackle letters from the PBM. 
The most common ones are:
Stating you need to switch pharmacies
Saying your medication is not on formulary, either due to a new plan or change in your current plan
3/13
The most common ones are:
Stating you need to switch pharmacies Saying your medication is not on formulary, either due to a new plan or change in your current plan3/13
Letter stating you need to switch pharmacies:If you like your current pharmacy,
DON’T PANIC, usually these letters only list their “preferred pharmacy”, not all the pharmacies still “in network”.Do: Save the info about the “preferred pharmacy” in case you need it.
4/
Do: Plan to refill at your usual pharmacy little earlier than usual (~7-10 days early is allowed by most insurance plans), so if you really need to make a switch, you have some on-hand.
This is a situation where I’m totally cool with short-term “hoarding” of meds.
5/13
This is a situation where I’m totally cool with short-term “hoarding” of meds.
5/13
Letter saying your medication is not on formulary, either due to a new plan or change in your current plan:Again,
DON’T PANIC, this happens all the time.Is it an expensive? Did it need a prior authorization (PA) when you started it?
Give the office a heads-up...
6/
... most plans let us submit a PA for the coming year anywhere from 2 weeks to a month ahead.
Do: Provide any new card numbers: BIN, PCN, RxGroup, and ID, even if your plan “hasn’t changed”.
Your insurance might be the same, but they may be working w/ a different PBM!
7/13
Do: Provide any new card numbers: BIN, PCN, RxGroup, and ID, even if your plan “hasn’t changed”.
Your insurance might be the same, but they may be working w/ a different PBM!
7/13
(Psst, bonus points: Be an angel and give those numbers to your pharmacist, too. 
)
Do: Plan on getting your next refill BEFORE the new year plan change, so you’ll have some on-hand while you’re waiting for the insurance company to approve that prior authorization.
8/13
)Do: Plan on getting your next refill BEFORE the new year plan change, so you’ll have some on-hand while you’re waiting for the insurance company to approve that prior authorization.
8/13
Next issue to tackle: COST. 
For most of us:
Premiums are going up
Deductible are going up
Copays are going up
9/13
For most of us:
Premiums are going up Deductible are going up Copays are going up9/13
Remember I suggested refilling your meds right the heck now?
Depending on your plan’s rules, if you did it today, you may be able to refill once more (just a touch early) before your deductible resets January 1.
It should give you another month to figure out next steps.
10/13
Depending on your plan’s rules, if you did it today, you may be able to refill once more (just a touch early) before your deductible resets January 1.
It should give you another month to figure out next steps.
10/13
Do: Refill brand name meds that have a copay card a day or two earlier in January than your generic meds. The amount the copay cards pay counts toward your deductible*.
*Exception: Plans w/ a copay accumulator, which could be it’s own whole terrible topic.
11/13
*Exception: Plans w/ a copay accumulator, which could be it’s own whole terrible topic.
11/13
So, in summary...
December: Refills now if possible, and once more before the end of the year.
January: Refill when you still have at least a week or two of meds at home in case of any hiccups (ex. pharmacy change or PA required), and ones w/ copay cards 1st.
12/13
December: Refills now if possible, and once more before the end of the year.
January: Refill when you still have at least a week or two of meds at home in case of any hiccups (ex. pharmacy change or PA required), and ones w/ copay cards 1st.
12/13
I hope these short-term tricks / strategies are helpful.
Final bonus points: Let your representatives know it is RIDICULOUS that we have to play these games for people to have access to medications in one of the wealthiest countries in the world. We need a better system.
13/13
Final bonus points: Let your representatives know it is RIDICULOUS that we have to play these games for people to have access to medications in one of the wealthiest countries in the world. We need a better system.
13/13
Extra, extra bonus points 
https://twitter.com/laurendc5/status/1336839036061757441
https://twitter.com/laurendc5/status/1336839036061757441
