Many individuals with pulmonary hypertension (PH) experience changes in their health insurance coverage or charitable assistance grants at the beginning of the year. In many cases, these changes mean that doctors’ offices and specialty pharmacies must take additional steps before prescriptions can be filled. Contact your PH doctor and specialty pharmacy now to reduce your risk of running low on medication if:
- You anticipate changes in your insurance coverage in January.
- You are seeking financial assistance to help pay for your January prescription refill.
Even if you will continue health insurance through the same carrier in 2019, you may be notified of changes in coverage, such as a medication being removed from your insurer’s formulary or a new prior authorization requirement. In these cases, your PH care team can help you get insurance coverage for the PH therapy you need, but they may need to complete additional paperwork or even file an appeal. Whether a change in your health insurance coverage is big or small, making sure that your PH doctor and specialty pharmacy are aware of the change will help your January refill go as smoothly as possible.
Contacting your PH doctor and specialty pharmacy also can be helpful if you are seeking financial assistance to pay for your January prescription refill. Although most PH prescriptions are written for 30 days, some individuals with PH are eligible for 60- or 90-day refills. Your PH doctor may be able to update your prescription so that you receive a multi-month refill in December, giving you more flexibility to find assistance funds in the new year.
Your PH doctor and specialty pharmacy also may be able to recommend additional financial assistance resources to help cover your medication costs in the new year. The Pulmonary Hypertension Association (PHA) lists information about nonprofit and manufacturer-specific patient assistance programs at www.PHAssociation.org/Help.