Patient Advocacy: Healthcare on your side

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

ADVIMEDPRO

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.

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.

AdvimedPro (424) 999 4705 or (877) 658 9446 fax (424) 226 1330

www.advimedpro.com contact@advimedpro.com

Monday, July 21, 2014

Patient Advocacy: Healthcare on your Side

Patient Advocacy: Healthcare on your side

by Martine G. Brousse,

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

Paying for Prescription Drugs

Part I: Infused or Injected *

Infused or injected treatments are common, ranging from a 32-cent B12 injection to thousand-of-dollars chemotherapy infusions. Due to medical and liability reasons, these are mostly given in office or facility settings, and are billed to Medicare under part A(inpatient) or B (outpatient or office), and to commercial insurances under the Medical benefits portion of the policy.

Many such treatments use brand-name drugs, often associated with prohibitive costs. These medications are not covered or payable under the Pharmacy benefits of your policy when administered in hospital or office settings.

There are options to lower your costs. Here are some tips:

1. Visit the Manufacturer's website

Almost all manufacturers offer so-pay assistance programs to self-pay patients, or those with a high share of cost. While income maximums may be in place, they are not mandatory. Grants can be generous ($ 24,000/yr for Herceptin from Genentech for example), but will not cover off-label (not FDA approved) use. Ask the office for an application form.

Self-pay or cash patients might qualify for free drug donations, based on criteria specific to each product.

Medicare, Medicaid or Tricare patients are prohibited by law from applying directly for funds, but may qualify for indirect assistance (see below)

2. Public & private Organizations

Every disease or condition has likely created an organization dedicated to its education and support. Cancer patients, for example, have access to various general federal agencies, as well as numerous private societies.There, should be listed general and focused charities, offering financial assistance and free resources. Healthwell or Copays.org are such well-known programs.

Please note that private funds often run out of funds early each month; applying the first week is best. Grants are not retroactive so requests should be made before a treatment starts.

3. Do it at home

Some infusion treatments, including those less complicated such as IV iron, IVIG, zoledronic acid for osteoporosis (Zometa, Reclast), etc, can be safely administered at home by a visiting nurse. Although the first regimen will be given in the office or facility to rule out any allergic reaction, subsequent home treatments may be cheaper.

Take too into consideration these hidden costs: time taken off work to go to the office, parking fees, the risk of infection in crowded waiting rooms, or the discomfort of leaving home when not feeling well (especially after a chemo treatment).

Injections such as growth factors for anemia (Procrit, Aranesp) or for neutropenia (Neupogen) for example, can safely be self-administered (syringes come pre-filled and require no medical background). Others like B12 injections can be administered at home via a home health agency. In these cases, your pharmacy benefits, or Part D will be responsible for the authorization, delivery and payment of the drug.

Calling your insurance carrier to compare costs, verify coverage and work the set-up is a must. As this option creates more paperwork for your doctor, and extends his legal liability beyond his active control, he is likely to be more supportive if most details, such as locating an in network home health provider, have already been worked out.

4. Use specialized mail order pharmacies.

If you are self-injecting at home without the help of a health agency, your prescriptions will be filled at your local or mail order pharmacy. Try contacting TNH or US Bioservices in such cases. They may not be contracted with your insurance, but their staff is trained to locate and apply for financial assistance on behalf of patients. This service can save you $ and efforts.

5. Question your physician

Convenience and habit may lead to prescribing costly regimens and medications when cheaper or generic alternatives are equivalent. Less expensive treatment options are often available, with the added advantage of having proven their value and effectiveness.

An active dialogue with your physician, especially when explaining your financial situation, can benefit both sides. After all, the office has an incentive to help you in order to get paid promptly in return.

In conclusion:

There may be more help out there for you than you may realize. I specialize in oncology, and know that for a fact for cancer patients. Asking the office staff is the first step, doing basic internet research is next. For those who are not computer-savvy, your local library, church or teenage neighbor may be helpful.

* as seen on NerdWallet

Next week: Part II: Oral Prescriptions

AdvimedPro (424) 999 4705 or (877) 658 9446 fax (424) 226 1330