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
- 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.
- 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.