One of my major pet peeves is the skyrocketing costs of health care, even for those of us lucky enough to perch under an insurance policy umbrella. Prescription drugs are the biggest bugaboo, and today's column offers plans of action to help defray out-of-pocket drug expenses that, quite literally, are sometimes the choice between a life-saving medication and food for your children's mouths. Thanks to Bottom Line Personal for suggesting methods to protect ourselves and our families.
Ellen Phillips * Keep current. It doesn't matter if you have Medicare's Part D, an Advantage plan or standard insurance, always keep up to date with your insurer's list of covered drugs ("formulary"). Check the list every quarter in the event your coverage for the drug itself or your co-pay amount has changed. Pay attention, too, when your doctor writes a script for a new drug. Call your plan before filling the prescription. If the new drug doesn't appear, ask your provider to prescribe an acceptable substitute; most insurance plans will accept generics.
* Ask Dr. Determined for help. If the insurance company removes one (or more) of your meds from its formulary, they must send their intent in writing. Your doc can step in to help maintain your health by: a) prescribing another drug on the plan's formulary; b) offering "step therapy," a move that tries the formulary's similar drug first. If it doesn't work, you're able to return to your original medicine; or c) filing an exception with the insurance company in which your physician explains the original medication is the only drug that effectively manages your condition.
* Search out free money. Most of the so-called wonder drugs we see advertised these days are overpriced and, if we experience a serious chronic condition and have to take one or more of these drugs for months or years, some of us might wish for a sooner death. Here's Bottom Line's example of Hepatitis C drug Sovaldi: A three-month course of Sovaldi can cost upward of $80,000, even if covered by your insurance plan. Following copays and deductibles, you'll fork over at least $5k monthly. This is where the Patient Assist Program comes in. Readers may remember I've advised this measure on many occasions, especially after the program helped so enormously with the costs of my mother's meds the last couple of years of her life. Most pharmaceutical companies offer the assistance plan (which isn't as philanthropic as one might think, as they make many billions of dollars to offset these "freebies") to folks who don't have insurance drug coverage or who are low-income. Additionally, these companies also extend benefits to patients who do have some insurance protection but can't afford the copays and deductibles. Check out RXAssist.org or Medicare.gov/pharmaceutical-assistance-program.
Contact Ellen Phillips at consumerwatch@timesfreepress.com.