What is a prescription co-payment and/or co-insurance?
A prescription co-payment and/or co-insurance is the portion of the covered drug that you are required to pay each time you fill a prescription, HometownRx pays the remainder. Usually, the co-payment is a flat dollar amount, and the co-insurance is a percentage amount of the drug cost. There are usually different co-payments for the generic, brand formulary, and brand non-formulary drugs. Check your Evidence of Coverage (EOC) for your specific co-payment information.
What is a pharmacy benefit deductible?
Some plans may have a pharmacy benefit deductible, which is the set dollar amount which must be paid by you for each calendar year for covered prescriptions before your co-payments, and/or co-insurance apply.
How can I pay a lower co-payment on a prescription?
When a physician prescribes a brand-name medication, you should ask if a generic drug is available to treat your condition. If a generic drug is not available to treat your condition, your co-payments will be lower if your physician selects a formulary over a non-formulary brand name drug.
What does “participating pharmacy” mean?
“Participating pharmacy” means a pharmacy has an agreement with HometownRx to provide covered services to our members.
What happens if I use a non-participating pharmacy?
Most drug benefits do not include coverage for non-participating pharmacies unless the prescription is obtained in conjunction with a covered emergency. If you fill your prescription at a non-participating pharmacy in an emergency, you must pay the pharmacy the entire cost of the prescription and then submit a direct member reimbursement form to HometownRx. If the claim is approved, your co-payment of co-insurance may be more or less than you have paid to the pharmacy than if you had used a participating pharmacy. Depending on the design of your benefit, you will also be responsible for any deductibles, and applicable co-payment/co-insurance. Check your Evidence of Coverage (EOC) for your specific co-payment/co-insurance information.
Why does my co-payment seem to change each refill?
If a medication cost (usually generic) is less than your monthly co-pay, HometownRx offers that price to the member. For example, your generic Tier 1 co-pay for 30 days supply is $15.00. The most you will ever pay for generic Tier 1 medication is $15.00 if the network pharmacy submits a cost of $7.50, for the Tier 1 generic you pay the $7.50. Therefore the cost can fluctuate each month based on the current cost of the medication. This may cause you to see a change in your co-pay each time you refill.
I am going on vacation and will need an extra supply of medications, what should I do?
If your medication is due to be refilled while you are on vacation, you can have it filled at one of HometownRx’s participating pharmacies nationwide. Depending on your pharmacy benefits, you may also be able to call us and request an early refill authorization at your regular pharmacy which will allow you to pick up your prescription before you leave town. To request an early refill authorization, please call the pharmacy services number on the back of your member ID card. If you use our mail order pharmacy, you can also request your refill be shipped to a different address while you are travelling.
If your question isn’t listed, check your Evidence of Coverage or call the Pharmacy Services number listed on the back of you Hometown Health ID card for assistance.