Tuesday, August 5, 2014

Patient Advocacy: Healthcare on your Side

Patient Advocacy: Healthcare on your side

   by Martine G. Brousse
Healthcare Specialist, Patient Advocate, Certified Mediator

Paying for Prescription Drugs
                                      Part II: Pharmacy Prescriptions*

Once mostly confined to providing oral medications, pharmacies have seen an influx of infused or injected drug orders in recent years. Due to a shift made by private insurers from Medical benefits to Pharmacy benefits (benefitting their pocketbook), the average patient's share of cost has climbed accordingly and substantially. Seeing a treatment through to the prescribed end is a struggle for many Americans: more than half never finish a treatment, mostly due to financial concerns.

But all is not lost, as several ways exist to reduce one's liability in addition to the options that were discussed in Part I of this blog. 

1. Be savvy

Few people pay full price when they know a good sale is happening elsewhere for the same item. Consider your prescription the same way. Your local pharmacy may not be the cheapest as your insurance contracted rates and policy are inflexible in determining pricing.

Ask about cash prices, they may be lower. Check out Costco, Wal-Mart and Target. Their prices are usually more affordable. Costco even offers $ 5.00 brand-name prescriptions. A membership is not required; by law the pharmacy service is available to all.

Check www.needymeds.com for direct links to coupons, rebates, assistance programs and discount cards.

2. Inspect your prescription

Do you really need a 90-day supply? Could you safely replace the more pricy prescription strength with 2 (or more) over the counter alternatives? Is there a generic equivalent? Can leftover pills you did not use up for a similar condition be taken instead? Ask your doctor!

Be aware of potential waste: can you start with a smaller amount, and get a refill once effectiveness has been established or allergic reactions ruled out?

A little research, and a call to your physician, may save you a trip to the pharmacy... and a bit of change.

3. Communicate with your physician/office

Your physician is unlikely to know your financial situation unless you bring it up. Ask for samples, or for less costly generic options. Ask if a drug manufacturer's rep can be contacted to bring in samples or help with an assistance application.

Explain that a high price may force you to skip on doses, stretch the supply by taking less than prescribed, or forgo getting a refill until your next paycheck is in. The physician should work with you to find a satisfactory solution. If your treatment must be altered or adjusted due to circumstances, your physician is best to determine how.

Inquire if the office supports a patient donation program. At the oncology practice I worked at as billing manager, patients donated the expensive growth factor drugs (in pre-filled syringes) they had purchased, and were not going to use to those in need.  

Work with the billing department to see if a prescribed oral treatment may be cheaper if done as an infusion in the office. This is the case for quite a few chemo drugs for example. Whereas the oral form is brand name, the infused version may be generic, saving you thousands of dollars. If your policy does not force you to use one form over the other, your (financial) wishes should be their command.

4. Check federal and state benefits

Patients with Part D have access to federal and state programs to help them cover the cost of prescriptions. For info on the Extra Help Program, PACE program or MTM program, call the Medicare Helpline at 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov

All patients can determine whether eligible for benefits by visiting http://www.benefits.gov/

5. Use your HSA or FSA account

The IRS allows a number of prescriptions, and over the counter medications to be paid with your HSA or FSA account. Your FSA will be lost to you if not used in full by the end of the year, make good use of it at your pharmacy.
For more info visit http://www.irs.gov/publications/p969/ar02.html or consult a tax professional as these expenses are usually considered medical, and might reduce your tax liability when paid out of pocket. 

In Conclusion

Prescription drugs are expensive, and finding a fair price may require time and research...on an ongoing basis. Trusting your preferred local pharmacy for any and all your prescriptions may be a thing of the past, replaced by the shopping around we already are familiar with for so many other items and aspects of daily life.   

©  [2016] Advimedpro.
©  [2016] Martine G. Brousse.
All rights reserved.

My objective is to offer you, the patient, concrete and beneficial information, useful tips, proven and efficient tools as well as trustworthy supportive advice as you deal with a system in the midst of sweeping adjustments, widespread misunderstandings and complex requirements

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