Accessing Treatments in 2016 - What You Should Know

Posted on December 17, 2015   |   

This blog entry was written by Jamie Sullivan, MPH

The new year can often mean new policies on medications that are covered for COPD patients, even when you are not switching insurance plans. As we approach January 1, the COPD Foundation wants to make sure you are prepared for any potential changes to what are referred to as formularies, the lists of drugs covered by your insurance company, and the cost you have to pay each month for those drugs. High copays, the set amount you pay at the pharmacy for each prescription you fill, have always been an issue that patients struggle to keep up with. In the past, a new year would often mean higher copays for patients. Unfortunately in the last few years, some large insurance companies have excluded certain drugs from the formulary altogether. A few patients in our community have experienced this switch, so we suggest everyone take adequate measures to prepare. It is unlikely you will be affected, but it is important to plan just in case.

Here is what you can do today:

  • Call, email, or go online and ask your insurance company if there have been any major changes to the 2016 formulary. You can specifically tell them your medication and ask whether it will continue to be covered in 2016. Ask if there are any changes in your co-pays so you can budget accordingly.
  • If you are told that your medication will no longer be covered in 2016, ask whether they have an appeals process and send this information directly to your physician for help.
  • Tell us about your experience. Your insurance company is not your doctor and there should be no reason for what we call "non-medical switching", i.e. you and your doctor determine the best treatment, but the insurance company switches you for no medical reason at all. Fill out a quick survey and learn more about the issues today.

We will stay on top of all of the treatment access issues and continue to work to collect the information necessary to fight these harmful practices throughout 2016.


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