We understand that details around insurance and prescriptions can sometimes be hard to decipher. That’s why we will use this article to answer common questions our users may ask us. Prescriptions and insurance plans can vary, but there are a few helpful rules to understand.
How long does a prescription last?
Depending on the prescription drug and the state that you live in, a prescription written by a doctor is generally valid for six months to one year from the date it’s written. Your healthcare provider can choose the written quantity of your prescription and your insurance company will determine how much of the medication you receive at a time. For example, your doctor may write a yearly prescription for you for a 90 day supply of pills with 3 refills. However, your insurance may only cover a 30 day supply at a time.
When your prescription expires or runs out of refills, your doctor will have to write a new prescription before the pharmacy can process it for you. The doctor may check to see if you have had any health changes before approving another year’s supply. At Twentyeight Health, doctors write prescriptions for 364 days with zero refills. Although “zero refills” may look confusing, it’s written correctly for a year’s supply.
Why is a prescription helpful for over-the-counter products like the morning after pill or internal condoms?
Getting a prescription for the morning after pill and internal condoms may allow it to be billed to your insurance, depending on your insurance plan. Under the Affordable Care Act requirements, insurance companies are required to cover certain over-the-counter (OTC) preventative medications at no cost to you. But this is only if a prescription is written for that medication. The prescription proves that you have discussed using the medication with your doctor and they deem it as medically necessary, which increases your chances of it being covered.
You can request a list from your insurance company of OTC medications that are covered under your plan. Getting a prescription will save you money if your insurance fully or partially covers the cost of these products. For example, the over-the-counter price of one morning after pill can cost as much as $40 to $50, and a 12-pack box of internal condoms can range from $110 to $245.
Why does insurance reject certain prescriptions?
Each insurance drug plan has a list of generic and brand medications that they cover fully or partially, which is called a formulary. Insurance plans update their formularies every year and sometimes make changes throughout the year. This is why the price of your medication may change, or a medication that was covered last year is no longer covered for you now. You can find the formulary list for your plan on your insurance’s website, so that you have this information handy when speaking with a doctor or the pharmacy.
Do I need to do anything when my insurance expires?
It’s important to keep an updated insurance card on hand. At the beginning of each calendar year, insurance companies may update the Member ID, RxBIN, RxPCN, or RxGroup on the card and then send the cardholder an updated version. If you have multiple insurance cards, it can be confusing. To find the card that is most up-to-date, you can look at the "issued" or “effective” date on the front or back of your card. The one with the most recent date is the updated card. It’s important to let your pharmacy know when you receive new card information, so they can update it in their system and bill your insurance information correctly.
For additional questions, you can reach out to your insurance plan or Twentyeight Health’s customer service team at firstname.lastname@example.org.