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Make a New Year’s Resolution to Better Understand Your Pharmacy Benefit

pharmacist going over pharmacy benefit with medicare member

For a lot of people, New Year’s resolutions center around improving their physical health. We are challenging you to keep yourself medically and financially healthy in 2020 by understanding your pharmacy benefit.  We’ve broken it down into three easy-to-understand steps below.

The first step in understanding your pharmacy benefit is to understand the medications you take every day.

  1. Read the instructions and make sure you are taking them as prescribed. If you aren’t sure, contact your personal doctor and ask them to go over the instructions and reason for the prescription.
  2. Keep a current list of medications that can be shared with all your providers. Bring it to every provider visit that you have.
  3. If cost of your medication is a factor in your usage, find resources to assist you. Work with your doctor, retail pharmacist and/or Network Health Pharmacist to review other cost-effective options.

The second step is to become familiar with any changes in your pharmacy benefit for 2020.

  1. Find out what your preferred retail pharmacy is because you may have a lower cost. Ask if there is an equivalent medication(s) at a lower cost or copay (tier) that can help you save money.
  2. Pain medications like Hydrocodone/Acetaminophen, Tramadol, Oxycodone and Morphine have additional restrictions on coverage based on guidelines established by Medicare, professional medical associations, the Centers of Disease Control and Prevention (CDC) or your retail pharmacy. A seven-day supply on the initial prescription and additional refills is now common and may impact coverage.
  3. Look at your health insurance plan benefits to find out what medications need prior authorizations or if they have quantity limits before they are covered.
  4. If you have diabetes, talk with your pharmacist or personal doctor about options available to help you monitor and keep your blood sugars under better control. Be informed about the changes to insulin coverage for 2020.

Third, if you are a Network Health member, tap into available resources.

  1. Create your own health care account on the Network Health online member portal. A wide array of information is available with this personal account to help you navigate health care benefits and costs.
  2. Use your Network Health pharmacist as another member of your health care team. We help our members every day with pharmacy related questions. Be sure to use this FREE service. Contact our pharmacy department at 920-720-1287 or 1-888-665-1246.
  3. Follow your health care providers suggestion. This includes getting a flu shot and eye exam, getting your blood sugar under control, taking medications as prescribed and regularly scheduling preventive exams.

Make good on your New Year’s pharmacy resolution and good health will be within reach in 2020.


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