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Armalyn Tesoro     Prescription coverage

Since there are several different kinds of drug plans available, it is important to know what kind of coverage you are entitled to. Drug insurance companies provide different types of benefits with different features and coverage options. It is good to be informed so as not to have any surprises when it is time to pick-up and pay for your medication. By knowing what kind of coverage you have, you can take advantage of your drug plan and have your prescriptions filled with ease and in a timely manner.

Anyone who is a resident of Manitoba is entitled to the provincial drug benefit program called Pharmacare. This coverage is free of charge but a deductible must be paid up front. The deductible you pay is based on your total household income. For more information about the Manitoba Pharmacare Program, please contact Manitoba Health at 786-7141 or visit

Other drug benefit plans may be available through your workplace or school. If you already have drug benefits or if you are looking to subscribe to a benefits plan, there are some things you need to be aware of.

Some health plans provide coverage for dental and travel, but may not include prescription drug benefits. If you have drug benefits, you are usually given a benefits card that has information needed by the pharmacy for filling your prescriptions.

Most pharmacies can send your prescription claim electronically to your insurance company as long as the required information is present. You should present your drug benefits card or have the information ready when ordering or picking up your medication.

Another thing to be aware of is some insurance companies require you to pay for your prescription first and then send in the receipt for reimbursement. Some insurance plans have deductibles. This is the amount that you need to pay out of your own pocket before your insurance pays for your medication. Depending on what coverage you have, there are different deductible amounts for single coverage and for family coverage.

Prescription drug plans provide single or family coverage. If your marital status changes you will need to inform your insurance company of the changes. Having a child will also affect your benefits so be sure to update your information when things change. A child over the age of 18 who is still living at home and attending school is still a dependent. You may need to inform your insurance company and may need to provide written documentation of your child’s enrolment in school.

There may also be limitations for drug claims that you should be aware of. Most plans will allow you to have a maximum supply of three months or 100 days. If you try to get more than this limit, your insurance company will not pay. So for example if you filled a three-month supply of a drug a month ago and tried to refill your prescription today, you would only be entitled to one month because you still have two months supply on hand. Insurance companies will not pay if you refill your prescription too soon. Some insurance plans also have limitations for the cost of drugs. This means your drug plan will only cover up to a maximum amount per year. There are however, some drug benefit plans that will cover the entire drug cost. Other drug plans will pay a percentage of your prescription leaving you with the remaining amount to pay for.

Another thing to be aware of is that not all drugs may be covered by your drug plan. Over-the-counter medication and drugs that are available without a prescription will not be covered. Some drugs may even need special approval from the insurance company. If you are not sure it is best to call your insurance company to find out if your prescription is covered.

With many different types of drug benefit plans available, select a plan that best suits yours and/or your family’s needs and be aware of your coverage details. Take advantage of your benefits and use your plan to its maximum potential. Doing so and being well informed of your drug benefits, you can save your time and money.

The above information is intended for educational purposes only. Always consult with your doctor, pharmacist or qualified health care professional to receive proper medical treatment.

Armalyn Tesoro is a graduate of the University of Manitoba with a Bachelor of Science degree in Pharmacy. She is currently working as a licensed community pharmacist at Wal-Mart on Ellice and Empress.

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