If your insurance coverage is changing in January 2021, act now to make sure your first medication refill of the new year arrives on time. Here are a few steps to take:
Update your PH care team. Many health insurance plans include prior authorization or step therapy requirements for pulmonary hypertension (PH) medication. Your health care team might need to complete new paperwork or file an appeal to give you seamless access to your therapy. Alert your health care team to your insurance change to allow them to tackle obstacles now and reduce the chances of delays in the new year.
Consider asking your health care team to prescribe a 60- or 90-day refill for your last refill of the year. Multi-month refills further reduce the risk of delays for those who are eligible.
Update your specialty pharmacy. Different health insurance plans work with different specialty pharmacies to deliver PH therapy. It often falls to people with PH to notify their specialty pharmacies that their health insurance has changed.
Review your financial assistance options. Changes in your health insurance coverage sometimes can change which copay assistance you’re eligible for. Manufacturer assistance programs, nonprofit grants and government-funded support programs have different eligibility criteria. Contact PHA’s Treatment Access Program for information. Call 301-565-3004 x749 or email us.