Frequently Asked Questions

A Concierge Pharmacist is a pharmacy care provider with additional experience, training, and time to address less common or more complex needs beyond a traditional pharmacist. They typically focus on certain specific patient population needs. This allows the Concierge Pharmacist to go further in depth with assessment, treatment plans and follow up with each patient. Concierge Pharmacists are also better able to identify gaps in a patient’s disease management and make recommendations to healthcare providers for additional opportunities to optimize a patient’s care.

Health insurance simply put is a system of collecting and pooling a small amount of money from a lot of people to help cover the cost for individuals in need. An easy example would be an organ transplant procedure which cost in excess of $100,000. Few people would be able to afford this themselves, but by collecting a monthly premium from thousands of healthy people, when someone does get sick and needs care, the insurance company can use the previously pooled funds to cover the cost.

Health insurance has become an extremely complex series of steps. Essentially, the goal is to collect funds from a larger group of patients and to distribute those funds as patient needs arise helping to offset the cost of care for each patient. With the current prices of healthcare many people would not be able to afford procedures and medications they need to get better. By grouping patient insurance premiums into a single account, insurance companies are able to cover the cost of services beyond the members individual contribution. Health insurance can at times be a frustrating complex arrangement but it also allows people to receive care they would not be able to afford on their own.

A health insurance deductible is usually a set amount of money the patient must pay out-of-pocket annually for medical services before their insurance starts covering costs. For example, if you have a $1,000 deductible, you’ll need to spend that amount on healthcare services first. After that, your insurance will kick in to cover expenses. Insurance deductibles are designed to require the patient to pay for the initial cost of care in an effort by insurance companies to help prevent excess usage or patients receiving care that is not necessary.

A prescription copay is a predetermined, fixed amount you’re required to pay when you receive specific healthcare services or medications. For example, if your plan has a $30 copay for a doctor’s visit, you pay that amount directly to the doctor at the time of your appointment. The copay is a way to share the cost of medical care between you and your insurance company. It’s important to note that copays are separate from deductibles and don’t usually count toward meeting your deductible. After you pay the copay, your health insurance will cover the remaining costs, according to the terms of your plan. A copay is also another mechanism created by insurance companies to prevent unnecessary services by requiring the patient to pay some amount for the service instead of it being completely free.

There are many factors that go into how much a copay is. One of the most common reasons is the cost of the medication itself. Many patients don’t realize their prescription copay is often only 5-10% of the cost of the drug. With newer medications still being under patent and only available in “brand” versions which tend to be more expensive, it’s not uncommon for the cost of a 30 day supply of a single medication to be in excess of $500-1000. So although a $50 or $100 copay is a lot, in actuality the patient is getting medication often valued at 10x or more their copay.

The second most common reason a copy can be very high is due to a patient receiving a medication that is not on the “formulary” of their insurance company. A health insurance formulary is like a menu at a restaurant, where instead of allowing a customer to order any food in the world, in order to streamline and reduce cost a formulary works like a preset menu. If you are trying to fill a medication that is not on the formulary often the insurance in an effort to get you to change to a formulary item will increase the copay cost as a deterrent.

The Medicare “donut hole” is often the third most common cause of high copays. The donut hole refers to a coverage gap in most Medicare prescription drug plans (Part D). After you have spent a certain amount on covered medications on your plan, you enter the donut hole. During this phase, you’re responsible for a higher percentage of your drug costs, which acts as another deterrent to the patient getting excess services. After reaching a second spending limit, you exit the donut hole and enter “catastrophic coverage,” where your costs go down significantly. Essentially, it’s like a temporary increase in your out-of-pocket costs for medications until you hit a spending threshold that triggers lower costs again.

Here is an example using the rates for 2023 to further demonstrate. Once you and your insurance plan have spent a total of $4,660 in 2023, you will move into the Medicare donut hole. In 2023, you pay 25% of the cost of your prescriptions, both brand-name and generic, once you reach the Medicare donut hole. So, if a certain medication costs $100, and you were paying a Tier 3 copay of $46 before you reached the gap, the same medication will now cost you $25 when you are in the gap. However, if that $100 drug were a tier 2 drug and you were paying a $10 copay prior to the coverage gap, you’d now pay $25 in the coverage gap.

Medicare continues to tally the spending between you and your insurance company while you are in the gap. If your total out-of-pocket drug expenses reach $7,400 in 2023, then you exit the gap. You reach the fourth stage of Medicare Part D, called catastrophic coverage. At this stage, you will pay either 5% or a small copay (whichever is greater) of the cost of your medications for the rest of the year. The insurance company picks up the rest.

Prior authorizations are an additional step in the prescription and pharmacy process. Due to the high cost of medications, insurance companies cannot afford to cover expensive medications that don’t have benefits for the individual patient. In an effort to reduce unnecessary costs, a prior authorization is often required for expensive medications or medications with a cheaper alternative. This process includes collecting information on the patient’s history such as what their diagnosis is, laboratory values which may have confirmed the diagnosis, as well as other treatments they have tried in the past.

To help prevent excess usage and cost, the insurance companies want to confirm the diagnosis is correct and that there are no other equally effective yet cheaper medications available for treatment. Oftentimes, before an insurance company will pay for an expensive medication they will require you to first try the cheaper alternatives which is called “step therapy” or “previously tried and failed” to further confirm the expensive medication is really needed.

A prior authorization is usually submitted through the website of the insurance company and can take anywhere from 5 minutes to 5+ days to be approved/denied. Some things that can affect the probability of approval is a detailed patient history, a copy of provider chart notes, and a list of previously tried medications and responses. In order for prior authorizations to be timely and successful, the patient, provider, and the pharmacy all need to work together to share and communicate information.

Due to the ever-rising cost of medications, many pharmaceutical companies create internal programs to provide discounts to patients at or below a certain income level. Each pharmaceutical company sets up their financial assistance program (FAP) internally and the requirements generally are different with each company. Although there are many criteria, the main criterion for eligibility is an annual income less than 2-4x the national poverty line (which is about $15,000 a year for an individual and $30,000 for a family of four in 2023). Often, patients in need are not aware they could be eligible for these FAP discounts. By working with a pharmacy with knowledge in identifying which patients and drugs are eligible, often significant reduction in cost is possible.

Drug manufacturer coupons are discounts available for eligible patients usually for 3-12 months for newer branded medications that are expensive. In a sales effort by pharmaceutical companies to increase market share for a new drug, often they are willing to make their drug available at a discount to incentivize people to use it. These coupon discounts can often be substantial. In many cases, allowing patient access to a drug therapy that usually costs $1000 a month for a patient copay of $10 a month or even less. These programs can be very impactful for patients on many expensive medications at once. However, there are some criteria which limit access to many patients using these programs. The most common barrier is these coupons generally are not available to patients on Medicare.

Auto-refill is an industry term used when a patient does not want to have to call and request medication be filled every time it is due. Instead the patient gives the pharmacy permission to refill the medication when the prior supply is about to run out. Auto-refill is most common on chronic or core medications which a patient expects to be on for the foreseeable future and doesn’t anticipate a dose change or suddenly discontinuing. Auto-refill helps make sure the patient always has medication and prevents unnecessary delays in a refill being processed due to communication delays between the patient and the pharmacy.

Medication synchronization, or “med sync”, is a process where the pharmacy works with the insurance company to create a refill interval where all the patient’s medications can be filled on the same day each month. Often, patients taking 5+ medications end up having different fill dates for each medication. This results in the patient needing to call or go to the pharmacy multiple times a month to get refills versus getting all their medications filled at the same time.

Medication synchronization is one of the most important steps needed for a patient to be successful. By having the patient’s entire profile refilled at once it significantly reduces the risk of communication errors, delays, less trips to the pharmacy and generally is essential for a patient to have a smooth streamlined prescription medication regimen. All the patient has to do is inform the pharmacist they want to enroll, the pharmacy calls the insurance company to get approval and within 24-72 hours the medication synchronization is set up and ready to go. This results in less calls to the pharmacy, less trips to the pharmacy, and fewer moving parts to cause issues for everyone.

Expired or excess medication is a fact of life these days. It is almost inevitable patients end up with extra medication or for medications which are taken on a as needed basis that expire. When patients have these extra medications lying around it can become confusing to caregivers and patients what is what and significantly increases the risk for medication error.

In an effort to promote patient safety we recommend patients separate and throw away expired medications. We also recommend that if a patient begins to accumulate an excess supply of a certain medication they inform the pharmacy for instructions on what to do with them. Prescription medication is not something we want to end up in the ocean or landfills when thrown out improperly. It is for this reason we ask all patients to locate their closest “medication return center,” which is a federally-licensed facility which has a protocol in place to properly destroy expired or unneeded medications. Patients can visit https://pharmacy.ca.gov/webapplications/apps/takeback/index.shtml, input their zip code and find their closest site. Due to the additional regulations and applications required to register as a medication disposal site, currently Your Personal Pharmacy is not an authorized medication disposal site,

Used syringes and needles pose a serious danger when handled improperly. In order to keep everyone at home and at the pharmacy safe, it’s important patients are properly educated on how to handle them. The first step is to make sure all used syringes and needles are put into a sharps container after being used. This is usually made of hard plastic and is colored red. The container is designed to not let the needle penetrate the container and make it safe to handle. If you don’t not have a sharps container common household items such as a plastic laundry detergent container or a plastic milk jug can be used instead. Once a sharps container is 75% full it should no longer be used. The container should be sealed and taken to your local registered disposal site. You can find your nearest site at https://safetyisthepoint.org/location-search/

We understand some people don’t want to come to the pharmacy once a month to get their medications for many different reasons. Making 12+ trips a year to get medications is not ideal, convenient or possible. At Your Personal Pharmacy we have designed our service model with exactly this in mind. We are able to offer all of our patients (who reside within the state of California) to receive all their medications by mail (free of mailing charge). This service method takes 2 business days or less and is considered the preferred method industry wide. In a further attempt to serve our patients, we offer 1 free in-person delivery every 30 days to your residence for patients who live within 25 miles of our location in Fallbrook California, as we understand some people are not comfortable with the mail or getting to their mailbox is a challenge.

Brand-name and generic pharmaceuticals are both regulated by the FDA and are designed to have the same therapeutic effects. The key difference is that brand-name drugs are patented and marketed by one company, often being the first to bring the medication to market. This means they can be expensive. Generic drugs are essentially copies of brand-name drugs, made after the original patent expires. They are usually cheaper because they don’t have the costs of research and marketing. Both types undergo rigorous testing for efficacy, safety, and quality. In rare cases inactive ingredients like fillers may differ, which could affect tolerability for some people. In our experience tolerability issues with generics occurs less than 5% of the time.

Your health is one of the most important parts of your life. It is not something to take chances with or take lightly. Healthcare is also an extremely complex, multifaceted process, which unfortunately means errors do happen. It is because of this Your Personal Pharmacy strongly believes every patient should speak with their pharmacist every single time they interact with a pharmacy. By doing this it allows the patient to not only get the attention they deserve, but it gives the pharmacist an opportunity to check in and make sure things are going good.

Over the years, countless studies have found that pharmacists are the most accessible healthcare professionals and this is something we take great pride in. We can also say over the years countless times we have initiated a significant number of intervention (and in some cases life saving) just by taking a few minutes to say hello and ask how things are going. At Your Personal Pharmacy, we are truly passionate about making sure you have the peace of mind you deserve and by checking in with your pharmacist at every interaction we further work to accomplish this.

Vaccinations are a crucial tool in the fight against infectious diseases, acting like a rehearsal for your immune system. When you get vaccinated, a small, safe form of the germ—or sometimes just a piece of it—is introduced into your body. This prompts your immune system to produce antibodies (immune system proteins) and train cells to recognize and combat the actual disease-causing pathogen in the future.

The importance of vaccines extends beyond individual protection; it’s a community effort. When a high percentage of the population is vaccinated, a shield of protection is created, known as “herd immunity.” This makes it difficult for the disease to spread, effectively protecting those who can’t be vaccinated due to medical reasons, age, or allergies. The collective benefit of widespread vaccination can’t be overstated. It has led to the eradication or near-elimination of diseases that once posed serious public health threats, saving countless lives and reducing healthcare costs. Therefore, vaccines are not only a personal health asset but a communal one as well.

Yes. For those who do not have a contraindication or allergy, most all patients over the ages of 12 should get a flu shot ever year. The influenza virus, commonly known as the flu, is a shape-shifter, constantly evolving through mutations. This rapid evolution means that the flu strains circulating one year might be different from those in previous years. As a result, your immune system’s memory from a past vaccination may not be effective against new strains. This is why you need an annual flu shot, tailored to combat the strains most likely to be prevalent in the upcoming flu season.

Getting the flu shot doesn’t just protect you; it contributes to community protection, or “herd immunity.” By reducing your likelihood of contracting the flu, you’re also less likely to transmit it to others, particularly those who are more vulnerable like the elderly, infants, or immunocompromised individuals. Moreover, even if you do catch the flu after vaccination, the severity of your symptoms will likely be reduced, decreasing the chances of complications like pneumonia. This lessens the burden on healthcare systems and reduces time off work or school, making annual flu shots beneficial on multiple fronts.

HICAP (the Health Insurance Counseling & Advocacy Program) offers free, one-on-one Medicare counseling. Trained volunteer counselors can answer your questions and help you understand your Medicare rights and benefits, including how to appeal denials of coverage, Medicare supplemental insurance (Medigap policies), Medicare Advantage plans, employee and retiree coverage, and long-term care insurance. Legal help and representation at Medicare appeals or administrative hearings are also available.

HICAP provides free educational presentations on Medicare and related topics. Call your local HICAP to schedule a presentation or find out about one happening in your area. (HICAP counselors do not sell, recommend, or endorse any insurance product, agent, insurance company, or health plan. The California Department of Aging administers this volunteer-supported program and CHA supports the HICAPs through trainings, technical assistance and up-to-date consumer materials, including our website and fact sheets.(https://cahealthadvocates.org/about-us/about-hicap/)

We understand people have busy lives and as much as our patients love Your Personal Pharmacy seeing us is often still an errand or chore. In an effort to address this, we have implemented a series of workflows to help minimize and prevent unnecessary or excessive pharmacy interactions. Through our comprehensive Assisted Pharmacy program, we are able to manage each patient with a single phone call every 30 days, that’s it. By having each patient speak with a pharmacist each time, in combination with our Assisted Pharmacy workflow that’s all it takes. During your monthly call your pharmacist will take the time to assess, review, communicate, and confirm all your needs, allowing us to get everything right the first time. For our patients who do want to receive additional check ins, we are available 10-6 PM PT Monday through Friday by phone, text, and email.

Refills, as simple as they sound, require a surprising amount of things to go right to be ready. Probably the most common call, question, or complaint in a pharmacy is “why isn’t my refill ready?” and we totally get it. Refills should be simple. They should be easy. Yet walk into most pharmacies and you will quickly hear a patient having to ask “why isn’t my refill ready.”

At Your Personal Pharmacy with our Assisted Pharmacy workflow this question will become a thing of the past. Patients run out of refills because most pharmacies end up being reactive instead of proactive. In an effort to speed things up, pharmacies tend to wait for a problem to occur to fix it, instead of working proactively and preventing them from occurring.

Other common causes of running out of refills occur because when your healthcare provider writes a new prescription, they have to include a certain number of future refills and once all of those additional refills are used a new prescription needs to be written. Generally, this process takes 1-3 business days and most pharmacies usually do not check for remaining refills until the day the patient expects their refill, which is what causes the delay.

Another common cause is when a prescription undergoes its last fill, many pharmacies do not proactively contact the provider at that point to get a new prescription. This is generally the most common reason why there are no refills left for a patient. Furthermore, when the pharmacy does identify when the last refill was used and request a new prescription the Pharmacy usually only sends the request once and never follows up to see if they actually got the new prescription.

The third most common cause is in the state of California a prescription is only valid for 12 months from the written date. This means that at least once every 12 months a prescription must be renewed by your Healthcare Provider. At Your Personal Pharmacy we guarantee we will have every refill filled and ready to go before you need it. We understand the time, frustration and suffering not having your refill ready when you need it can cause. A part of our Assisted Pharmacy workflow we proactively monitor and manage refill requests beforehand every time, guaranteed.

Refills not only run out but they can also be early. In the case of an early refill, this generally means that based on the date your prescription was last filled, and the day supply or quantity provided then, the patient still has more than 3 days of medication left and thus “is too early.” This occurs primarily because the insurance company doesn’t want to provide excessive medication to the patient and requires the patient to wait usually 3-5 days before the prior fill day supply runs out to approve the next refill. Having too much extra medication on hand really can be a bad thing. One of the most common causes of patient medication error is the patient not realizing they have two bottles of the same medication and they end up taking both at the same time. By requiring the patient to take all of the previously dispensed medication, it further reduces this risk.

We agree getting a 90 day supply is often a good thing. It reduces on average the number of trips to the Pharmacy from 12 times per year to 4, as well as further reducing the risk of patients running out of their medication and missing doses. Generally, most insurance companies and most medications are eligible for a 90 day fill. However, there are some exceptions which tend to occur with high cost medications. The reason for this occurs with many chronically taken medications which often require dose changes over the treatment cycle for a patient.

An example of this is a patient is taking a diabetes medication such as Jardiance 5 mg, after being on it for 6 months they go to their Healthcare Provider who determines the patient’s labs are still not at goal and the patient needs a higher dose. The Prescriber writes a new prescription for 10 mg and sends the patient on their way. However, oftentimes, the patient just recently filled their Jardiance 5 mg, maybe even the week prior. Which at this point means the patient might have as many as 80+ tablets of Jardiance 5 mg at home they may not need.

In the case of Jardiance, which is approximately $15 a tablet, the above situation would result in $1200 worth of medication possibly going to waste. Imagine that occurring with thousands of patients every month who share the same insurance company. It is for this reason that some medications, especially those that are expensive or likely to require a change in dose, are not available in a 90 day supply or in order to prevent them have a significantly higher copay (more than 3x) than a 30 day supply.