How to ensure you get the medication you need – when you need it

By Kimberly Pellicore

Two patients go to the same doctor, receive the same diagnosis, and go to the same pharmacy to have their prescriptions filled. One patient leaves the pharmacy with their prescription in hand and the other leaves with nothing.

Sounds like the beginning of a bad math problem, but it is actually an all-too-common scenario in many of America’s pharmacies. Many are leaving without the prescriptions they came in for. But why?

Dennis Williams, PharmD, a faculty member at the Eshelman School of Pharmacy at the University of North Carolina at Chapel Hill, cites drug formulary status and shortages as two prominent factors.

“The most frequent reason a pharmacy is unable to fill an asthma or allergy prescription is a change in formulary status for different medications,” Williams says.

The formulary is the name for a list of brand name and generic drugs covered under a specific insurance plan. Some plans have tiered formularies with drugs divided into groups, most often based on cost.

Although some medications are still available after a change in formulary status, if the medication is classified as non-preferred by your health benefits plan, then the copay may be much higher than preferred or generic drugs, Williams says.

A drug shortage is often precipitated by manufacturing problems at the company facility or by shortages of raw material. Some medications are discontinued or taken off the market due to health risks or low manufacturer profits.

Another potential roadblock for patients is high insurance plan deductibles. With high deductible plans, the insurance will cover the prescription, but not until the patient has met the deductible. Until the deductible is met, the cost of life-saving medication may be astronomical.

Here is what you should do if you find yourself in one of the above situations:

  • Call your physician. “Without knowing the patient ran into a roadblock, the doctor cannot help with finding an alternative medication covered by insurance, nor can they find a less costly medicine for those facing a high deductible,” says Kelvin Shaw, MD, a board-certified allergist and immunologist in Houston.
  • Ask your physician if they have coupon cards available for the specific drug they are prescribing. Be sure to review details of the coupon card with them before going to the pharmacy. If you run into difficulty despite the coupon card, call your physician to see if their office is willing to troubleshoot the issue directly with the pharmacy.
  • Ask your pharmacist if they can advise you on possible money-saving options.

Kimberly Pellicore is a freelance writer and the mother of two children, one of whom has severe, multiple life-threatening food allergies and asthma.