-Frequently Asked Questions-

• What does a pharmacist do?  What goes on behind the scenes at the store?
• I have XYZ insurance.  What will my co-pay be?  How much is my prescription?
• Are independent pharmacies more expensive than big chain pharmacies?
• How should I choose a health plan?  What questions should I ask to find the best drug coverage?
• What is mail order pharmacy?  Do I have a choice?
• NYS Board of Pharmacy Consumer Information FAQ's
• What is a generic drug? What if I have many questions about generics?

To choose the best pharmacy benefits package follow these steps:

1. List all of the medications taken by you and all family members who would be covered. Be sure to include dose and frequency (how many times a day you take the drug).

2. Ask if there is a DRUG FORMULARY, or a list of covered and non-covered drugs. Ask for a copy of the current formulary for your plan. Bring it in to us, we can help estimate costs and prevent future problems.

3. Determine the copay structure of the plan. FYI - most insurances use a "TIER" system. The first tier is the lowest tier, and normally consists of generic drugs. Copays are normally the lowest in this tier. The second tier is normally reserved for brand name drugs. These copays can be 2-3 times as much as Tier 1 drugs. Tier 3 is considered a "Non-preferred" or "Non-covered" drug tier. Some insurances charge a very high copay, while some make patients pay the full cost, with no help from the insurance. Some insurances block whole categories of drugs from being covered, like "cosmetic drugs", drugs for weight loss, or drugs for erectile dysfunction.

4. Compare your medications to those listed on the formulary. Mark you drugs as covered and non-covered, or as Tier 1, 2, or 3. The drug formulary is a powerful tool, since it is your "Heads Up" on drug coverage.

5. Is your pharmacy of choice a participating provider? Some insurances block smaller pharmacies from participating. Some pharmacy benefits require you to get the drugs from a mail order pharmacy.

6. Determine the impact of switching. Is this plan going to cost more? Are the drugs I have been taking going to require paperwork to be filled out (sometimes referred to as prior-authorization)? Is one or more of my drugs limited to a certain number of doses per month? Do I have to switch medications around anyway? Do I have to switch pharmacies or use mail order?

Your pharmacist can normally review a formulary rather quickly and give you a brief synopsis of what will happen if you switch pharmacy benefits. Feel free to bring a copy of the formulary to us for review.

***Since Village Apothecary is a medical equipment vendor, also check on the reimbursement rules for braces, crutches, wheelchairs, etc***

What is mail order pharmacy?  Do I have a choice?

Mail order pharmacy is a way to reduce the expenses of operating a pharmacy.  Prescriptions from a wide geographic range are sent to one central place for processing.  The prescriptions are then delivered, normally by Post Office, FedEx or UPS to your door step.

Initially, these pharmacies were not popular.  The personal relationship of pharmacist and patient is lost.  No patient wanted to lose the ability to ask someone they know and trust questions about their medications.  If there was a problem, who do you call?  Most of the time, it’s a stranger answering phones on a 1-800 number.

Also, the patient is responsible for doing all of the leg work.  The patient was responsible for getting new prescriptions, faxing them to the mail order pharmacy, and making sure there always were enough refills.  All this has to be done with up to 2 weeks notice, or the patient may go without medications.
Community pharmacies have been providing these services since their doors opened.  Taking care of the paperwork ensures patients are compliant with their medications and their diseases are treated effectively.

But, the mail order pharmacies smartened up.  They lower the cost of the medications to the patients, by lowering the co-payments dramatically. 

For some patients, the hassle of mail order pharmacy became worth it.  For others, they were forced to use mail order pharmacies.

A great example of a mail order pharmacy is the Veteran’s Affairs (VA) Pharmacy.
Insurance companies, seeing this as a way to control costs, opened their own mail order pharmacies, directly competing with the community pharmacies.  Then, they force plan participants (PATIENTS!) to use their mail order pharmacy only.

See our document, Comparing Community Pharmacy to Mail Order, to see more information on how Community Pharmacy can win over mail order. 

Would you accept a mail order doctor?  What if you mailed in your medical chart with your current systems to another state and got a diagnosis in the mail or over the phone?    Doesn’t make sense, does it?
You do have a choice.  Voice your opinion to your benefits manager and decision makers in your company.  Let them know you want your medical care to be done locally, by people you know and trust.