Frequently Asked Questions: You asked, we answered!

We take pride in providing medications at the lowest cost. There are many nuisances to finding prescription savings, but our staff is dedicated to helping you find the best price, something many chains can’t offer. We accept most insurance plans, but keep in mind that there are few plans that restrict patients to mail order or chain pharmacies only.

This is a common question. We do not accept GoodRx for many reasons, primarily because as an independent pharmacy, we are able to set our own prices. Nine times out of ten, this will give you a better price than GoodRx can at a chain pharmacy. We also have our own ‘discount card’ available at many doctors’ offices for both prescriptions and compounded medications.

While a particular manufacturer cannot be guaranteed, Carolina Pharmacy is good at finding medications and products that other drugstores cannot. Different pharmacies use different wholesalers, but we purchase medications from various vendors, which gives us access to a wide variety of products.

Health insurance plans have a formulary (a list of drugs that are covered by the plan) which vary across health plans. Common reasons a medication may be excluded from a formulary are 1) the plan wants you to use a different drug in the same medication class, 2) the medication is available over-the-counter, or 3) the drug is considered a lifestyle drug, and therefore not medically necessary (ex: weight loss, erectile dysfunction, cosmetic procedures).

Health plans restrict formularies in order to save money by steering you to a less expensive option, often by making copays for medications that are similar but more expensive. Your plan may cover the more expensive option once you try similar medications first and your doctor submits a prior authorization, to document why you need that particular medication.

Many chain pharmacies will not start the prior authorization process until they receive a call from the patient and doctor, delaying the approval from your insurance company. In order to start and submit prior authorizations in a timely manner, we’ve established close relationships with providers so you can get the medications you need.

We fill all new prescriptions sent in by your doctor, so if it’s something you’ve never taken before, we will have it ready before you call. Carolina Pharmacy also has a medication synchronization program that aligns all of your medications so that you can pick them up on a day that is convenient for you on a recurring basis. We will never sign you up for this service without talking to you first, but we do encourage all patients to participate, as it lowers costs and decreases your number of trips to the pharmacy.

What many patients don’t  know is that insurance companies monitor adherence. When a patient doesn’t pick up their maintenance medications-such as for blood pressure, cholesterol, or diabetes, for instance, it flags the insurance company. And if the patient is late for their pickup too many times, this can cause their insurance premiums to go up.

For non-controlled substances, insurance companies only cover a certain days’ supply of medication. So, in order to ensure insurance will cover it, a patient may only fill it a certain number of days in advance. For controlled substances (and depending on the medication), by law the pharmacy can only fill the medication every thirty days. This is to prevent drug abuse and diversion.

The supply is calculated by dividing the total quantity by the number of pills you take per day, as prescribed by your doctor.

Just like gas prices, medication prices can fluctuate. Typically this is not an issue when you have prescription insurance, although prices may still change if you switch drug plans or have a deductible. For patients with a deductible (a predetermined amount the insured must pay out-of-pocket before the insurance plan will help), prescription copays are typically highest at the beginning of the year.

For patients with Medicare, their costs may go up later in the year due to a coverage gap, more commonly known as the “donut hole”. For example, when total drug costs exceed a predetermined limit, a patient enters the Part D phase of Medicare prescription coverage. (In 2020, this limit was about $4,000.) Afterwards, the patient is responsible for 25% of drug cost until they reach the catastrophic phase, when total out-of-pocket costs reach about $6,000.

GoodRx is a price-comparison platform for medications that offers coupons for prescription drugs. It can be critical to know beforehand whether your pharmacy accepts GoodRx, particularly for low-income patients.

The brand name of a medication is the name given by the company that develops the drug. The generic name is that of the active ingredient in the medication. Generic drugs have the same quality active ingredient(s) and effectiveness as brand drugs. The difference is in their inactive ingredients, such as dyes, fillers, and preservatives. Also, generic drugs are much cheaper. If the company has cheaper costs for development and marketing, this makes it more affordable and more readily available.