The RxSS Pharmacy Support team never knows what a member might ask on a support call.
Questions could be on a wide range of prescription matters. They come from every type of person and place in America. Many who call in are simply trying to understand prescription pricing or how their benefit works.
For our dedicated, experienced pharmacy professionals on the other end, the goal of each conversation is to provide clear answers, better understanding, and often a lower-cost prescription for that member. First come the questions…
We asked the team to name the three they hear most often. What do these questions tell us about today’s pharmacy consumer? See what the answers have in store.
“Who Are You and What Do You Do?”
Many are not aware of what Rx Savings Solutions (RxSS) is, the services we provide, and how we are different from a member’s insurance provider. When members hear about or get a call from us, they often assume Pharmacy Support is reaching out from their insurance company or to fill their prescription.
“One of the first things we do is explain that we are a service provided as part of your benefits package through your health plan or employer,” said Taylor Drake, a Pharmacy Support Supervisor. “That’s usually all it takes, and once we verify their identity, then we can start to help them with whatever they’re calling about.”
Consumer confusion can be common in healthcare. Especially when so many different parties could be involved in something like a prescription—the prescriber, medical insurance provider, pharmacy benefit manager, pharmacy, or a care coordinator. Members do not need to know how they are all connected. They just want a solution.
“Why Does My Medication Cost So Much?”
It is common for members to call us with sticker shock after leaving the pharmacy. This might occur with a new prescription or one a member has been taking for years at a lower out-of-pocket cost. Few consumers understand how the same drug might cost them $200 on a recent fill when it was $25 last year, or how it can be a much different price than a friend pays.
We try to explain everything that determines their prescription cost, and how those factors may change from year to year or even month to month:
- Coverage details of their specific health plan, including preferred pharmacies
- Formulary tiers in the pharmacy benefit, and how a drug can move from a lower to a higher copay or be removed entirely
- Whether a deductible exists and applies to medical and pharmacy costs combined or separately
Despite efforts by employers and health plans to improve medication access, affordability, and benefits navigation, so many members still struggle. Solutions like RxSS can be invaluable.
Our team hears the impact every day. Whether a problem can be solved easily or with extra effort, we know it is worth it because they are more likely to stick to a prescription they can afford.
“Can You Help Me?”
Typically, after the first two questions, we have figured out how to help that member. In many cases, they have already tried calling their insurance company’s member support line or looking online. Our goal is to go beyond assistance. We want members to have all the information they need to make informed decisions.
That means diving deep into the member’s insurance plan to uncover not only what is driving the cost of their prescription but also whether lower-cost treatments are available on their formulary. The solution is often as simple as:
- Evaluating prices across in-network pharmacies, including both retail and mail order services
- Exploring generic or therapeutic alternatives
- Determining the optimal day supply based on member’s plan requirements
This team feels like we bridge a communication and information gap between patients and insurance providers. I estimate that 90% of what we do is education and advocacy. Our team members are passionate about what they do and are experienced enough to know the best course of action.
My colleague Julia Salazar, another Pharmacy Support Supervisor, summed it up this way: “We might not have the answer right away, but we will stay on the phone with you until we do. If we need to bring in another expert, we don’t just cold transfer the call and disappear. We make sure you get the answer you need.”
Whatever the question may be…
Take a closer look at the RxSS Pharmacy Support team.
