Three things to know to become a pharmacy pro

Published January 1, 2022

There are hundreds of reasons you might find yourself walking up to the window at a pharmacy. Maybe you have a child with strep throat in need of antibiotics or take medicine to lower your blood pressure or manage diabetes. Whatever brings you to the pharmacy, there are a few basic things that are helpful to know when you get there.

First, always be sure to have your Blue Cross Blue Shield Member ID card with you when you go to pick up your prescription. Health insurance can help cover some of the costs associated with prescription medications and the pharmacist will need your insurance information to determine how much you pay, and how much is covered by insurance. Here are three more basic things to know to help you become a pharmacy pro:

1. What Prescriptions Does My Insurance Cover?

Health insurance companies have a list of preferred drugs which have been designated as safe and cost-effective.  This list is called a formulary. The list contains different levels, called tiers, which help determine how much you’ll need to pay out-of-pocket for your prescription.

You can find a list of the prescription drugs covered by your plan on your Blue Cross Blue Shield company’s website, or by calling the 1 800 number on the back of your member ID card. The pharmacy may also be able to access this information.

2. Is A Generic Version Available?

Taking generic versions of prescription drugs can be an effective way to save money at the pharmacy.  Like other non-brand name items you find at the store, generic drugs contain the same active ingredient and dosage as the brand name version and work in exactly the same way, but usually cost less.  This is because when the patent on a brand-name drug expires, other manufacturers can apply to the FDA to make a generic version.  Generic versions are only approved if they are proven by the FDA to be equally safe and effective as the original. Talk with your doctor or pharmacist to see if a generic version of your prescription is a good option for you.

3. What Is Prior Authorization?

Occasionally, some prescription drugs require an extra review to ensure it is the right medicine for the situation. Drugs require prior authorization for a variety of reasons, such as when a drug has dangerous side effects or can be harmful when combined with other drugs; when a drug should only be used for certain health conditions; when there is a less expensive drug that may work better; or when a drug is often misused or abused.

If your prescription requires prior authorization, you or your pharmacist should contact your doctor so he or she can provide the necessary approval, or select a different medication for you that does not require prior authorization.

Your doctor, pharmacist and your local Blue Cross and Blue Shield company all share the common goal of ensuring you have access to the best, most affordable prescription medications to help you live a healthy life.  All three are happy to answer your questions and work with you to find the best solution for your health and your budget. If you would like to learn more about your prescription drug coverage, visit your Blue Cross Blue Shield company’s website.