The Benefit of Mail Order Pharmacies

If you have commercial insurance and have seen us for dry eye, the chances are, we have sent your prescription medications to mail order pharmacies. Despite what people may think, this is not to our benefit, but yours. (There are no kickbacks, that's illegal and a misconception)

We see patients with hundreds of different insurance plans, and it is impossible for us to know them all. It is also unrealistic to expect patients to know their drug formulary as well. But despite this, insurance companies have preferred medications, and many times, it's a straight up guessing game on what medications are covered by an insurance company. Enter: Mail order Specialty Pharmacies.

If a doctor prescribes a medication that is not on your formulary, many times you will go to pick it up and it will cost thousands of dollars. Many times, the provider has no idea until a patient calls to complain. However, when we use a specialty pharmacy, it works differently. Drug companies allow patients to circumvent their insurance to get a much more affordable cash pay price, should they use a specific pharmacy.

Here is how it works:

Step 1: Doctor sends prescription to the mail order pharmacy

Step 2: The pharmacy will contact the patient to confirm insurance coverage, address, and payment

Step 3: Insurance either approves or denies the medication.

Step 4: When an insurance denies a medication, the pharmacy will automatically send the doctor a prior authorization notice, and keep the patient informed every step of the way

Step 5: The insurance denies the prior authorization. At this step at a regular pharmacy, the patient will pay a very high price or be forced to switch medications. However...

Step 6: The pharmacy has an agreement with the drug company to offer an affordable cash pay price to the patient, and the patient gets the original medication prescribed by their doctor.

Why this works:

1. The doctor is able to prescribe the most effective medication for the patient

2. The patient gets the most affordable price, and their medication gets mailed directly to their doorstep

3. The pharmaceutical company wins because their medication gets prescribed more often

4. The pharmacy wins because they get a better price on medications by being the main pharmacy for one medication, and get more prescriptions sent to them by doctors

5. The entire population wins, because as doctors continue to prescribe the best medications, even if insurance companies deny them, in the long run, the medication is more likely to get put on formulary the following year as the insurance company continues to get requests.

   
   

While this process can seem tedious, we believe it is important to have patients on the most effective medication, and not just what they are strapped to based on their insurance company.

Unfortunately, many times this process is not available to patients with government insurance like Medicare, Medicaid, BCBS Federal, Tricare, etc. Although there are a few medications that are available at capped prices for these patients.

At McConkey Eye Care, we do our best to stay up to date with this process in order to provide you with the best medications to help treat your ocular surface issues.