How Often Do Insurers Change Their RX Guides and how Important is the "RX Fill Within" Section?

[Bod]

1. Just wondering how many dramatic RX guide alterations your typical FE insurer will have and how often?
2. When writing an application, how crucial is the RX Fill Within section of the RX guide? I assume underwriters are very strict with this?
3. What happens if the fill date isn't available?
4. What happens if a medication isn't present in a particular insurers RX guide? Does that mean they don't care about it and will approve the app? Or is it more "murky" than that?

 

[Todd King]

1. Just wondering how many dramatic RX guide alterations your typical FE insurer will have and how often? It doesn't change that often.

2. When writing an application, how crucial is the RX Fill Within section of the RX guide? I assume underwriters are very strict with this? Keep it simple. If the app asks the question, then answer it.

3. What happens if the fill date isn't available? The company can see the fill date in the ScriptCheck, if they run one.

4. What happens if a medication isn't present in a particular insurers RX guide? Does that mean they don't care about it and will approve the app? Or is it more "murky" than that?

If it's not there, then it's not there. Of course, make sure you look for generics too.

 

[Bod]

If it's not there, then it's not there. Of course, make sure you look for generics too.

Thanks, Todd. Regarding my fourth question, if they don't include a certain medication in their RX guide, does that mean the insurer isn't concerned about that medication at all? Or does that generally mean they'll come to the decision on their own, behind closed doors, and maybe they'll take that medication into account?

 

[Jerard]

Thanks, Todd. Regarding my fourth question, if they don't include a certain medication in their RX guide, does that mean the insurer isn't concerned about that medication at all? Or does that generally mean they'll come to the decision on their own, behind closed doors, and maybe they'll take that medication into account?

Not meaning to jump in for Todd, but some carriers have an agent's list and then a more in depth one they use. You an always call and go over the meds with an underwriter but they'll still go by MIB for their final answer.

Some companies want you to list all meds on the app and some don't. But you need to find out what they are taking so you know which company to write them with. Let's take the example of Warfarin. RNA will take it with no problem but Trans will want to know the original reason for taking it. Many others won't accept it at all. If the client is taking it simply to reduce blood clotting then they're OK with it. If it's for an "event" like a heart attack then they may not.

You also have to find out if the med the client is taking is considered "treatment" or "maintenance". Each company will be a little different. Maintenance is normally OK but treatment is what is asked on the app. Again, it's recommended to call and talk to an underwriter.

One more thing...I've never had to find out a fill date.

 

[Todd King]

Thanks, Todd. Regarding my fourth question, if they don't include a certain medication in their RX guide, does that mean the insurer isn't concerned about that medication at all? Or does that generally mean they'll come to the decision on their own, behind closed doors, and maybe they'll take that medication into account?

See Jerard's comment below. It's much more in depth than what I said before.

Not meaning to jump in for Todd, but some carriers have an agent's list and then a more in depth one they use. You an always call and go over the meds with an underwriter but they'll still go by MIB for their final answer.

Some companies want you to list all meds on the app and some don't. But you need to find out what they are taking so you know which company to write them with. Let's take the example of Warfarin. RNA will take it with no problem but Trans will want to know the original reason for taking it. Many others won't accept it at all. If the client is taking it simply to reduce blood clotting then they're OK with it. If it's for an "event" like a heart attack then they may not.

You also have to find out if the med the client is taking is considered "treatment" or "maintenance". Each company will be a little different. Maintenance is normally OK but treatment is what is asked on the app. Again, it's recommended to call and talk to an underwriter.

One more thing...I've never had to find out a fill date.

Not a problem! You are much more thorough with the answer than I was. Thank you for that!

 

[Bod]

Thanks, Jerard!

One more thing...I've never had to find out a fill date.

Why not? (I'm new.) If you look at RX guides for most insurers, they include the RX Fill Within column in their RX tables and some companies seem to determine what plan the applicant would qualify for based on when a prescription was last filled.

Do most FE brokers disregard this column?

 

[Jerard]

Thanks, Jerard!



Why not? (I'm new.) If you look at RX guides for most insurers, they include the RX Fill Within column in their RX tables and some companies seem to determine what plan the applicant would qualify for based on when a prescription was last filled.

Do most FE brokers disregard this column?

Keep in mind I can only speak regarding the companies I have. I do a medical evaluation with each client and I do ask how long it's been since they've taken the med. In most cases I only need to know if it's over 2 years. But I go with a close approximation on that and have never had to be so exact as to have to list the actual "last fill" date. Also, the more info you put down the better, within reason, of course. Before a phone interview it's sometimes good to tell the client to only answer the questions that they are asked and not to volunteer anything.

 

[VolAgent]

Thanks, Jerard!



Why not? (I'm new.) If you look at RX guides for most insurers, they include the RX Fill Within column in their RX tables and some companies seem to determine what plan the applicant would qualify for based on when a prescription was last filled.

Do most FE brokers disregard this column?

The "fill within" column is to help you. They don't care what your answer is, they will go by the Script check or the insured if they ask the insured.

 

[donamese]

Thanks, Todd. Regarding my fourth question, if they don't include a certain medication in their RX guide, does that mean the insurer isn't concerned about that medication at all? Or does that generally mean they'll come to the decision on their own, behind closed doors, and maybe they'll take that medication into account?

There are thousands of medications so most companies will just list the more common and definitive medications. Some put together a larger list than others but none are all-inclusive.

 

[Bod]

The "fill within" column is to help you. They don't care what your answer is, they will go by the Script check or the insured if they ask the insured.

Thanks! So it's safe to say the underwriters take this portion very seriously? Which would mean, in order for me to know what plan someone will qualify for, it's in my best interest to look at the dates on the bottles and take note?

I'm still a little confused about the insurers with less-detailed RX guides. I don't like the idea of leaving whether or not an application will be approved up to chance. Especially if these insurers _are taking_ certain unlisted prescriptions into account and they're just not telling producers about it.