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Specialty Pharmacy Tips from the Community

Here are tips from the community about using specialty pharmacies.

"I'm a Financial Counselor at a RE office. For patients that have a dollar limit for infertility on their insurance that includes medication costs in that limit, I always suggest that patients question the pharmacy on how much they are billing the insurance for the meds vs. how much the self-pay price is. Pharmacies often charge the full "regular" rates to the insurance which can quickly eat up a large chunk of your benefits; there is usually quite a savings if you self-pay for the medications vs. having them billed to the insurance. Patients then can even turn in the receipts and bill the insurance themselves if they still have remaining infertility benefits. That way, the lower rate that they paid is taken from their benefits instead the higher rate that the pharmacy would have billed. I've had some patients tell me that it saved them over $1,000 (and even as much as $3,000 SAVED) by doing this. For patients that may have a $10K or $15K limit, this is HUGE and could be the difference between having enough benefits to cover the cycle or maxing out on benefits. If infertility meds count towards a benefit maximum, I ALWAYS urge patients to at least educate themselves and ask this difference and decide from there." - Kristin O

"If someone is lucky enough to have insurance, really look into the prescription drug coverage. My HR person has NO IDEA we even had an in network specialty pharmacy. It was very unclear what this was on my insurance website and I just barely found out about it by looking up my prescription drug coverage and calling Triessent. The website did not give enough information about the program in my opinion, and since my HR person had never even heard of it BCBSIL is not promoting it." - Kristin

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Add your general tips about using specialty pharmacies in the comment box below. Please do not mention the names of any pharmacies in your comments.