HR Fast Facts: How Can Employees Get Reimbursed for Pharmacy Expenses?

December 5, 2022
HR Fast Facts: How Can Employees Get Reimbursed for Pharmacy Expenses?

Ultimately, the best source for finding how to get a pharmacy expense reimbursed will be through carriers. However, we have compiled some helpful tips below.

Reimbursements for pharmacy expenses within 30 days

  1. Claims filed within 30 days of the prescription being filled can be directly reimbursed through the pharmacy where the prescription was filled/purchased.
    • The plan member will need to present their carrier ID card and a receipt showing the amount they originally paid.
  2. The pharmacy can then run the claim for the prescription through the carrier's pharmacy claim system and provide a reimbursement for any costs that were previously paid out of pocket.
    • Reimbursements do not include copay amounts.
    • Some pharmacies will allow direct reimbursements for up to 90 days, but 30 is a good rule of thumb.

Reimbursements for pharmacy expenses after 30 days

  • If the 30-day direct reimbursement period has passed or the pharmacy will not honor the receipt, the plan member would need to submit a claim form through their carrier's pharmacy vendor.
  • These claim forms can be obtained on a carrier's website.
    • Reimbursement through the carrier typically takes 30 days.
    • The carrier will issue payment directly to the member.

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