Pharmacists are expected to educate patients and healthcare professionals about drugs. That makes sense. But since our healthcare delivery system in the U.S. is far from simple, I believe we sometimes have to offer some insights and instruction on other things too. Case in point: The Prescription Insurance Card.
In fact, in my 20+ years practicing retail pharmacy I can testify that I have found this little issue to provoke far more anxiety and confusion than any instructions related to taking or using your pills. “Take one tablet daily” is pretty easy. But when I ask “Do you have a prescription insurance card?” I often get that “deer in the headlights” look, a strange mixture of panic and frustration, like those dreams where you imagine your teacher handing out a test for which you are utterly unprepared.
Let me see if I can help.
The “prescription insurance card” issue can be confusing. The origin of this confusion tends to be related to the fact that you MIGHT have a separate card JUST for prescription insurance coverage, or you might not. In fact, for many participants in our American healthcare system, you typically can have up to 3 separate “health insurance” cards in your wallet or purse (yes, I know, you cou ld have even more).
- Your Medical Insurance Card
- Your Dental Insurance Card
- Your Prescription Insurance Card
Your medical insurance card typically identifies your coverage for things like doctors (office visits), hospitalizations and emergency department visits. You may see little abbreviations on this card like “OV” (office visit) or “ER” (Emergency room) or “BH” (Behavioral Health). This card typically has your ID number, Group Number and other identifying information. The back side often has phone numbers for you to call about your coverage.
Dental coverage is strictly for the care of your pearly whites. Don’t bother showing that to the pharmacy. We sell toothpaste, but we don’t clean teeth.
Your prescription insurance card tells the pharmacy how to bill for your prescriptions. This is always a different process and system than is used by doctors to bill for their services, though the information needed might be on your medical insurance card. Health plans typically separate out their financial structure between “medical” and “prescription” benefits. For this reason, and several others, the process of billing for prescriptions is very different than billing for office visits, lab work or hospitalizations.
NOTE: I am not suggesting everyone has all these types of medical insurance. I know many do not. This article is simply about trying to explain the nature and existence of this often confusing little prescription insurance card.
DO YOU HAVE A SEPARATE PRESCRIPTION INSURANCE CARD?
If you have a prescription plan through Medicare Part D, then you will always have a separate and specific card for that prescription coverage. Medicare Part D is an optional prescription program available to Medicare eligible patients only. If you enrolled, they will send you a card.
For standard commercial or Medicaid patients, it isn’t always so easy. One way to find out if you have a separate prescription card is to look at your medical card. Does it have a little “Rx” anywhere on it? Does it have a “BIN” number anywhere on it? Does it have the word “prescription” anywhere on it? These MIGHT indicate that this card also serves as your prescription benefit card.
Even the mere existence of an “Rx” or the word “Prescription” on the card doesn’t necessarily mean this is your prescription insurance card. The best clue is the presence of the “BIN” number. This is used exclusively by pharmacies to process your prescription claims. In fact, the pharmacy typically needs up to 4 numbers to accurately process prescription claims for you (a BIN number, PCN number, Group number and ID number). Maybe with some work they could make it a bit more confusing. But I don’t think so.
As a last resort, if you are unsure if you have a separate prescription card for your prescription benefit, simply call the customer service number on the back of your medical insurance card. They should be able to look up your policy and tell you.
CARRY YOUR PRESCRIPTION INSURANCE CARD ALWAYS
You should always know where your prescription insurance card is and carry it. Save yourself a lot of frustration and figure out if you have a separate card for prescription coverage, and if so, where it is. If your prescription and medical insurance information are both on the same card, that is great. But otherwise, be sure to have them BOTH with you, especially whenever you might need a prescription for you or a dependent. Having only your medical insurance information will often be of no help in getting your prescription drugs covered.
IT’S A NEW YEAR – HAS YOUR CARD CHANGED?
I’m posting this now because in January many patients will be getting a new prescription insurance plan. Maybe last year your medical and prescription coverage were both included on the same card. This year might be different. If your benefit is through an employer, they may have changed insurance companies (or you might have elected a different plan). Whatever the case, figuring out if you have a prescription benefit, and which card identifies that coverage, is an important part of navigating our healthcare system.
Here’s wishing you the best of a new year, with hopes for a little less confusion at the pharmacy counter.
©Jason Poquette and The Honest Apothecary. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Jason Poquette and The Honest Apothecary with appropriate and specific links to the original content..
Last modified: April 17, 2023