Prescription and Medical Insurance Are Different
Students are frequently asked if they have prescription insurance when they bring their prescriptions to the WSSU Wellness Center Pharmacy. Frequently, the student will produce a medical insurance card that lacks the necessary prescription insurance details.
We can’t do much for students at this stage except suggest that they phone their parents and inquire about the “lost card” or card information. Students despise hearing this and frequently claim that their “other” drugstore has always been able to utilize their cards!
In truth, the other pharmacy requires or would have required identical prescription card information, and must have obtained the customer’s prescription insurance information from another source, such as the patient’s family or a local drugstore.
Basic insurance card education is the greatest method to avoid this issue. Insurance cards should always be carried by insured individuals, but before stuffing them into their wallets, take a moment to read the information on the card. In most cases, the data will be presented in one of three ways:
Prescription Card from BlueCross BlueShield
When a medical insurance company refuses to pay medications, the prescription insurance company’s information is printed in the top right corner of the given card.
Prescription Insurance Card from United Healthcare
When a medical insurance company refuses to cover a prescription, the information for a prescription insurance company that will cover it is printed on the same card.
The pharmacy is seeking four pieces of information, regardless of the insurance company.
- The Bank Identification Number (RxBin) directs a claim to the appropriate insurer.
- RxPCN – the Processor Control Number – narrows the claim down even more to the exact insurance ID – the member’s unique identity number.
- The prescription group number (RxGrp) indicates the group plan the member ID belongs to.
- The pharmacist can correctly submit a claim to the appropriate insurance with those four numbers. If the insurance card does not contain the words Rx or RxBin on it, it is most likely not their prescription card, and the consumer will need to look for that information.
Faculty, staff, graduate students and retirees enrolled in the U-M Health Coverage are eligible for a prescription drug plan. The plan covers outpatient medicine requirements with prescription drug coverage through a countrywide network of retail pharmacies.
The plan also includes a handy mail order service with lower maintenance prescription copays. Magellan Rx Management manages the drugstore network and provides services to members.
A list of generic, brand and specialty pharmaceuticals covered by the plan can be found in the prescription drug plan formulary. Medications that require particular handling, administration, or monitoring are known as specialty pharmaceuticals.
Even if your doctor is not affiliated with Michigan Medicine, specialty pharmaceuticals on the formulary are covered when filled at the University of Michigan Specialty Pharmacy.
Announcements and modifications to the drug plan can be found in the News and Updates section.
- When you enroll in a university health plan, you will also be immediately enrolled in the university prescription medication plan, with coverage beginning on your service date.
- The persons covered by your prescription drug plan are the same people who are covered by your health plan.
- Prescription drug coverage is not available without health coverage, and vice versa.
- Several weeks after registering, you will receive an ID card from Magellan in the mail. Your member ID number will be the letter “U” followed by your U-M employee ID number, as stated on the front of the card.
The prescription drug plan has no annual deductible. Copays are organized into tiers, each with a distinct degree of copay. Prescriptions must be filled at a Magellan Rx pharmacy, which includes mail order and the University of Michigan Specialty Pharmacy.
- Tier 0: Preferential Insulins and Affordable Care Act Preventative Products – no copay
- Tier 1: Generic Drugs, which have a low copay.
- Tier 2 – Intermediate Copay for Preferred Brand Name Drugs
- Tier 3 – Non-Preferred Brand Name Drugs — high copay, as well as the possibility of a product selection penalty.
Certain drugs and supplements, including over-the-counter products, are also accessible with no copay under the Affordable Care Act with a signed prescription from your health care physician. For further information on the drug plan tiers, see Coverage and Drug Information.
How to Cut the Cost of Prescriptions
- Use mail order for qualifying medicines for convenience and possible copay savings.
- Find the lowest-cost choice for your meds, examine your Rx history, and locate a pharmacy near you with the Magellan Rx member site. Now is the time to register (you will need your ID number).
For a covered generic, brand, and specialty medicines, refer your doctor to the U-M Prescription Drug Plan formulary.
- When possible, ask for generics in a 90-day supply, as this can help you save money on your medicine.
- Certain preventative products, including over-the-counter (OTC) medications, are covered by the prescription drug plan with a $0 payment under the Affordable Care Act with a valid prescription from your health care physician.
- Consider taking advantage of a free or reduced-cost prescription program, such as those given by retail drugstore chains. You’ll still need a prescription and your University of Michigan Prescription Drug Plan card.
- Use a Health Care Flexible Spending Account (FSA) to pay for prescription copays and many over-the-counter drugs using pre-tax cash (with a written prescription).
Insurance for Prescription Drugs
You will be immediately enrolled in OptumRx prescription drug coverage as a member of the Boston University Health Plan. When your doctor writes a prescription for you, you have options for where and how it is filled.
To manage your prescriptions, sign up for OptumRx.
You can register with OptumRx once you’ve registered in a health plan. You can use the site to manage your prescription drug benefits if you are a registered member. Refill prescriptions, sign up for text message reminders, track your orders, check the status of your claims, and more are all available through their mobile website.
Prior approval is required.
OptumRx covers prescription medications that are medically essential. Prior authorization is required for some drugs in order for them to be covered by the plan. Visit the OptumRx website to learn more about a specific drug.