Is your insurance coverage changing in January 2022? If so, take these steps to avoid treatment delays, such as prescription refills or prior-authorization renewals.

Update your pulmonary hypertension (PH) care team
Notify your health care team about insurance changes right away. The sooner you notify them, the more time they will have now to address potential obstacles and avoid delays in the new year. Many insurance plans include prior authorization or step therapy requirements for PH medication. Your care team might need to complete new paperwork or file an appeal to give you seamless access to your therapy.

Plus, consider asking for a 60- or 90-day supply for your last refill of the year. Multi-month supplies can reduce risk of refill delays in January, if your insurance allows them.

Contact your specialty pharmacy
Notify your specialty pharmacy when your health insurance changes. Insurance plans work with specific specialty pharmacies to deliver PH therapy, so your pharmacy could change if you get new insurance. Check with your specialty pharmacy to see whether an insurance will affect how you receive your PH therapy.

Use PHA’s specialty pharmacy feedback form to share positive experiences or service challenges. PHA will send your comments to our contact at your pharmacy.

Review your financial assistance options
Changes in your health insurance coverage can sometimes change your copay assistance eligibility, particularly when transitioning from employer-based to public programs such as Medicare or Medicaid. Eligibility criteria differs for manufacturer-assistance programs, nonprofit grants and government-funded support programs.

Learn more, call PHA’s Treatment Access Program at 301-565-3004 x758, or email us.