Maximizing Your Health Insurance Benefits in the New Year

By Olivia Kinney, PharmD

If your insurance (including your prescription coverage) is changing along with the calendar year, you may be wondering what you can do to prepare and get the most out of your new benefits. Here are some helpful tips:

Look up your new plan’s formulary to make sure your current prescriptions are covered.

  • What’s a formulary? A formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits.
  • How do I find the formulary? Most plans have an online portal readily accessible through search engines, or you could call the insurance company to ask for this information. Keep in mind, the pharmacy does not have access to your insurance company’s formulary, so locating your plan’s preferred medication can help us help you!
  • What do I do if my medication is not on the formulary? Reach out to your prescriber or pharmacist to start the process of switching to a preferred alternative medication. Don’t worry! Any alternative medication selected for you is likely in the same medication class and should continue to help manage your medical condition. Changing medications when necessary can keep your cost down and health up.

Request medication refills a bit earlier to allow time for potential prior authorizations.

  • What’s a prior authorization? An approval is sometimes required by a health plan before you fill a prescription so the medication can be covered by your insurance.
  • Starting the refill process early means your pharmacy staff will have time to work through any insurance coverage changes for you in the new year.
  • Ask for a 90-day supply of your medication! This means you’ll come to the pharmacy less often to refill your prescription.

Investigate other cost-savings options.

  • Have you heard of the Kroger Rx Savings Club? We’ve partnered with GoodRx to help you save money on your prescriptions. If your medications have gone up in price or if you prefer to stay on your current medication instead of switching to your insurance plan’s formulary alternative, consider signing up for the Kroger Rx Savings Club to pay often lower club prices than your insurance copay.

Maximize your new insurance benefits!

  • Make sure you're up to date on vaccines. Adults need routine vaccines to avoid vaccine-preventable illness. Vaccines are often available from your pharmacist for a $0 copay!
  • Take advantage of medication management services. Many Medicare Part D plans and some commercial insurances cover services like medication reviews provided by your community pharmacy. These services are at no cost to you and facilitate focused, one-on-one time with your pharmacist to review your medications. Be sure to take advantage of these services if offered by your plan or pharmacy.
  • Check for ways to save on out-of-pocket costs for over-the-counter items. If you have a high-deductible health plan, certain OTC items may be purchased with your Health Savings Account funds. Check with your insurance company to find out if you can save on out-of-pocket costs!

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