Navigating the System

Empower yourself as a patient, and learn how to get the most out of your benefits. Each plan is different, so this section of our guide will help you understand what it is that you should look for when you receive your insurance information.  This section will help you navigate the health care system when you need care.

Topic Area: Prescription drugs

Does mail-order vs. retail matter when I’m getting a prescription?

Retail pharmacy

  • The NH Insurance Department requires an insurance company to make available a retail pharmacy locally.  This is a licensed pharmacy that is open to dispense prescription drugs to the public without requiring the patient to receive medical services from a provider or institution affiliated with that pharmacy. 
  • Retail pharmacies have pharmacists on staff that can be a valuable resource to patients who have questions about their prescriptions, including potential interactions with other medications, or additional information about contraceptives.  
  • Pharmacists often working more closely with primary care providers and specialists to better manage patient health.  A pharmacist may also be able to provide you with additional information on more affordable options regarding your prescription medication treatment.
  • Your pharmacist will most likely substitute a brand name prescription with a generic, unless your physician has specified that the brand name is medically necessary. 
  • The prescription from your physician may not be covered under your benefit formulary.  In many cases, the pharmacist will contact your physician to see if there is an alternative medication, but you should not rely on the pharmacist to do so.  Your physician most likely does not know what medications are on your benefit formulary.  If a medication is not on your formulary, it won’t be covered by your health insurance unless it is an unusual circumstance.
  • Your doctor is likely to send the prescription to your preferred pharmacy electronically, instead of giving you a paper prescription or faxing the prescription.  This can save you time at the pharmacy, and is an opportunity to reduce costs in the health care system.  If you did not receive a paper prescription, you should confirm that your pharmacy is receiving the prescription electronically.   Learn more about ePrescribing in New Hampshire.
  • The New Hampshire Legislature passed a requirement that health insurance companies permit patients to synchronize their medication fills, with no additional cost to the patient.  This will assist those patients who would otherwise need to make repeated trips to the pharmacy to obtain their medications as the supply of each is depleted.  The legal requirement does not take effect until January 1, 2019, but your insurance company may be providing this opportunity to patients now.  You may wish to call them and find out if medication synchronization with no additional cost sharing is available now.  Learn more about the legislation 

Mail order may save you money and time

  • When you use a mail order pharmacy, you often pay a much smaller copay and may get a longer supply of the medication.  Mail order pharmacies are often jointly owned and managed by the pharmacy benefit manager or Health Insurance Company that provides your coverage.
  • When you use mail order to get a 90-day supply of your prescription, many health insurance plans charge you the same amount that you would pay for three months’ worth at a retail pharmacy. Check your plan Summary of Benefits and Coverage or more detailed benefit information for additional information.  

Getting started with mail order

  • If your health insurance plan has mail order pharmacy benefits, use the mail order pharmacy that is listed in your Summary of Benefits and Coverage Document. Coverage for your prescription may be less, or it may not be covered at all, if you use an out-of-network pharmacy. Learn more.
  • Check your plan’s website or call customer service for the mail order pharmacy order form. You’ll need to complete this form and send it in the first time you fill your prescription.
  • Your doctor’s office can fax the prescription directly to the mail order pharmacy, or you can send it in along with your order form. Allow 10 to 14 days for delivery.
  • If you need your medication right away, have your doctor write two prescriptions – one for a small amount that you can fill right away at the pharmacy and one for mail order.
  • Refills are easy. In most cases, you can call or go online to get a refill.


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