Question of the Week:  I just got a new prescription from my doctor, and my pharmacist told me that my drug plan will only allow a 30 day supply to be dispensed. WHY? 

When you get a new prescription filled, you may find your Insurer has applied a limit to the number of pills you are allowed to be reimbursed for under your Benefits Plan.   We are often asked why this limit is necessary.

The “Initial Days’ Supply” - that is, the number of days you are allowed to claim,  will vary by:

• the type of prescription (is it for an acute condition of short duration, or is it a new drug for a long-term (maintenance) condition?
• the type of drug (it may be a very high-cost “specialty” drug)

Why are these initial limits imposed?

There are three reasons a new prescription may have limits:

1. You may suffer side effects which are unpleasant or intolerable.
2. The drug does not mix well with other existing medications you are taking, and may cause severe or adverse reaction. Until these are determined, it is best to exercise caution when taking a new drug.
3. The drug may be extremely expensive, which makes imposing limits more imperative. By imposing a limit, both the drug wastage and cost expenditures are minimized if it in fact becomes evident that you cannot tolerate the drug.

Sometimes drugs that are normally prescribed for acute conditions can be used as a long-term medication to treat a chronic condition. In these instances, you may apply to the Insurer for authorization to obtain a supply for 90-days to reduce both your dispensing fee costs over the long term, as well as the inconvenience of going to the pharmacy for frequent refills.

Do you have a question on how your drug plan work, or would you like to see us address other topics relevant to your group benefits plan?  Feel free to get in touch with our office!