Is your insurance changing in 2023? If so, make sure to update your care team and specialty pharmacy. Give your health care team plenty of time to tackle potential obstacles by notifying them right away of any insurance changes. Don’t wait till the new year.
Many health insurance plans include prior authorization or step therapy requirements for PH medication. Check if your care team needs to complete new paperwork or file an appeal to give you seamless access to your therapy.
Remember: Your care team also can help you with other issues, even if your insurance is staying the same. Whether there’s a problem with your prescription refill, your copay assistance grant has run out, or your insurance is rejecting your coverage, they usually can help.
Here are other ways to set yourself up for success in 2023:
Order a multi-month refill. Ask your care team to make your last refill of the year be a 60- or 90- day supply. If your insurance covers multi-month refills, your treatment is less likely to be disrupted in the new year. Remember: You might have to wait while your health care team submits an annual prior authorization request for your prescription.
Similarly, patients often are responsible for notifying specialty pharmacies that their health insurance is changing. Your new plan might use a different specialty pharmacy than the one that currently delivers your pulmonary hypertension (PH) therapy. Check with your specialty pharmacy to see whether an insurance change will affect how you receive your PH therapy.
Check your drug formulary. Make sure you know which medications your insurance plan’s drug formulary includes. Even when your insurance plan doesn’t change, sometimes medication coverage will vary from year to year. Before the new year, ensure your medications will be covered as expected.
Confirm your financial assistance eligibility. When your health insurance coverage changes, sometimes your copay assistance eligibility changes too. Eligibility criteria differs for manufacturer assistance programs, nonprofit grants and government-funded support programs. Contact the Pulmonary Hypertension Association (PHA)’s Treatment Access Program to learn about your options for financial assistance. Call 301-565-3004 x758 or email us.
Thanks to Janssen Pharmaceuticals for its 2022 support of PHA’s Treatment Access Program.