How to Troubleshoot Prescription Refill Delays
Prescription refills can cause stress for people with pulmonary hypertension (PH), especially when they don’t know whether their medication will arrive in time. Specialty pharmacies try to ensure patients don’t experience medication disruptions, but errors sometimes happen.
The Pulmonary Hypertension Association (PHA) asked several specialty pharmacies about what you can do when you risk missing a medication dose or need an early refill.
Running out of medication
If you’re about to run out of medication (five or fewer days of medication left), contact the pharmacy as soon as you can. Each pharmacy has a dedicated patient care team to help you complete refill requests on time. They also can troubleshoot problems with refills. Pharmacies suggest reaching out by phone or online portal, depending on your comfort level with online forms.
When you reach out to the pharmacy, tell them how many days of medication you have on hand. Most pharmacies said they could ship medication overnight to prevent missing doses. In most cases, they said they wouldn’t charge patients for overnight shipping.
Most insurance plans have a limit on when they can process the next refill. Often that means you have to have used 75% of the medication before the refill process can begin. However, some plans have a more stringent 85% limit. Others limit refills to within 10 days of exhausting the medication supply. These plan-imposed limitations can delay when the pharmacies ship your next month’s supply, but your pharmacy can’t do anything to speed that process.
Specialty pharmacy patient care teams
Accredo/Express Scripts: 866-344-4874
AllianceRx/Walgreens Pulmonary Team: 800-445-3674
CVS Specialty PAH CareTeam: 877-272-2738
OptumRx: 855-856-0536
Refill delays related to billing issues
It’s important to let your pharmacy and your health care team know if you’re struggling to afford your copays or can’t refill your prescription because of outstanding account balances or other billing issues.
Many people with PH struggle to afford their treatments. Don’t be afraid to mention financial hardship. Ask your pharmacy if it has a financial assistance or social worker program to provide patient support. You also can tell your prescriber if you have challenges paying for your medication. The treatments most affordable to you can vary according to your health insurance coverage.
Most pharmacies have dedicated teams to address billing issues. They also have staff who are experienced with finding financial assistance options.
PHA regularly updates its financial assistance resources page. See the list, email our treatment access program or call 301-565-3004 x758 to learn more about financial assistance options.
Early refills for travel
When you know you’ll be traveling during your usual refill period, be sure to plan ahead. Call your specialty pharmacy to request an early refill. Most insurance plans require pharmacies to submit vacation overrides to fill prescriptions early. Note: Some plans allow only one vacation override a year, so make sure you know your insurance company’s limitations.
You also might need to coordinate with your prescriber for a REMS override, especially if you’re travelling internationally or for more than 30 days. PHA has many more tips to review when planning travel, including checklists and letter templates for your physician to fill out. Be sure to do your research before any major travel.
Other troubleshooting suggestions:
- If you are stable on a therapy, you can schedule advance shipments for the full calendar year. The pharmacy will remind you an order is coming and check if you need any changes before it ships your medication.
- Use the communication method that’s easiest for you. Pharmacies usually offer refill reminders through phone calls, texts or emails. Schedule the order right away when you get the reminder to avoid unnecessary delays.
- In case inclement weather or other natural disasters prevent mail delivery to your zip code, pharmacies might be able to ship your medication to a different location, or to your doctor’s office.
Specialty Pharmacy Feedback Form
Having trouble reaching your specialty pharmacy? Use PHA’s Specialty Pharmacy Feedback Form. Our treatment access program manager can help connect you. While you shouldn’t use this option for emergencies, it can be helpful in addressing repeated or ongoing issues with refill deliveries or billing challenges.