4. The Pharmacy Staff Advocates on Your Behalf
If medications are not covered by your insurance company, the pharmacist and/or technician must offer solutions for you. Here are a few examples of how your pharmacist can advocate on your behalf:
- If a medication is not covered by your insurance company, the pharmacist will contact your physician to discuss the situation and switch the medication to something similar if indicated. For example, your doctor prescribes Lipitor (atorvastatin) for your high cholesterol and it is not covered by your insurance plan. The pharmacist will then contact your doctor to discuss this and your doctor may change your cholesterol medication to Crestor (rosuvastatin) or another drug that would be appropriate for you and is covered by your insurance
- If your doctor wants you to have a medication that is not covered by your insurance company, the pharmacist will work to obtain a prior authorization for the medication from your insurance company
- If your insurance company denies a medication your doctor has prescribed, BUT you must have it as it is medically necessary, then your pharmacist will work with you to obtain the medication from the patient assistance program from the drug manufacturer
- If your ADAP coverage or any other insurance has expired, your pharmacist works with you to get your insurance reinstated. Your pharmacist also assists you in accessing resources and ways to get you access to your medications
- Pharmacist and staff are able to refer you to community resources that can assist you with other issues that you may be having, e.g. legal aid, support groups, housing, food, transportation.
5. The Pharmacy Must Always Have Your Medication in Stock
You must never run out of your medication. Adherence to your HIV medication regimen is critical in maintaining your health, and not allowing opportunities for drug resistance to arise. If the pharmacy does not have your medications in stock then they are promoting your non-adherence. If the pharmacist is not an HIV expert, then you may not get all your medications filled at the same time, the pharmacist does not know how to counsel you on your regimen, and you may start taking only half the regimen, resulting in drug failure and resistance.
6. You Must Always Receive a Consultation on New Prescriptions or Prescription Changes -- It's the Law
Taking HIV medications is a big commitment on your part. You have to take them every single day and not miss any doses. The consultation from the pharmacist is critical so that you understand exactly what to expect -- and when you are done, feel comfortable taking your meds. The pharmacist will review your medications and make sure you fully understand what each one is for, how to take it, when to take it, side effects, drug interactions and anything else you can expect. Remember to ask the pharmacist any questions that you have as relates to your medications. Remember, there is NO such thing as a stupid question. The pharmacists should always be available to answer your questions.
Comment by: Anonymous
Sun., Mar. 3, 2013 at 10:33 pm UTC
Good information but just a note that some of us are no longer given options in choosing our pharmacy. As of this year, my employer's health plan will not cover any meds taken for more than 60 days, unless you get them through the one and only mail order service they offer, which is not a specalty pharmacy. It seems to be the new trend.
Comment by: Anonymous
Wed., Feb. 27, 2013 at 1:36 pm UTC
this article scare me too much, enough worries already I don't need this, I purchase from my neighborhood walgreens,no problems so far of what is discribed in this article
Replies to this comment:
Comment by: Michelle
(Dana Point, CA)
Wed., Feb. 27, 2013 at 9:06 pm UTC
it sounds like you're at the right pharmacy and getting great care, no need to stress about it
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