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Learn the language of your health insurance plan
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(ARA) - How well do you understand your prescription health care plan? Could you answer these three simple questions?
* Are you required to use generic medication first? Do you have an option to try a brand name medication if the generic medication doesn't work?
* Does your health care plan have you pay a co-pay for medications? Does your health care plan have you pay a percentage of the medication cost?
If you didn't know the answers to all of those questions, you're not alone. Many prescription health care plans change constantly, but it's important to understand these changes and understand the language your insurance plan is using so you can be sure you are getting the best treatment under your health insurance plan.
The following are definitions to some common terms.
Step Therapy: An approach to medication coverage that requires treatment with covered drugs in a therapeutic category before coverage is authorized for other medications in that category. In this process, your insurance will only grant you access to the treatment option prescribed by your physician after other treatment options have failed. Patients are encouraged to become knowledgeable about the protocols required by their health care plan versus those that are recommended.
Generic Substitution: If a generic medication is available, your health insurance plan may require you to take the generic instead of a branded medication. This practice often saves you and your insurance plan money while providing similar efficacy and safety. But not all medications have generic equivalents approved by the FDA, and generic medications are not always as effective as different branded drugs in the same class.
For example, the cholesterol medication Zocor(R) (simvastatin) has an FDA approved generic version known as simvastatin. However, simvastatin is not a generic equivalent to other cholesterol medications. Likewise, the cholesterol medication CRESTOR(R) (rosuvastatin calcium) does not have an FDA approved generic equivalent. CRESTOR is indicated to slow the progression of atherosclerosis - the buildup of plaque within the arteries - at any stage of the disease as part of a treatment strategy to lower cholesterol to target levels.
It's important to remember that each patient is different. For some patients, depending on cholesterol levels, a generic statin may be appropriate. For others, a therapy like CRESTOR(R) (rosuvastatin calcium) may be appropriate.
Formulary: A formulary is a list of drugs that are considered preferred medications that are meant to be used by your physician when prescribing medications.
If you are not able to get the medication your doctor recommends, it may be because the product he or she has requested is not on your health plan's formulary. It would be unlikely to not be able to get CRESTOR through your insurance plan if your doctor prescribed it.
More than 90 percent of patients with commercial or Medicare Part D insurance are reimbursed for CRESTOR and most state Medicaid formularies have CRESTOR on their preferred drug lists. (Fingertip Formulary. Data accessed: Percentage of covered lives - Commercial Plans. Accessed August 17, 2009. Defined as Tier 1 through Tier 7 on Medicare MA, Medicare PDP, and Medicare SN by Fingertip Formulary as of January 2009. Data include covered lives whose prescriptions may be subject to step therapy requirements. Fingertip Formulary. Data accessed: State Medicaid Plans. Accessed August 17, 2009.)
It's important to work with your doctor and ask questions about what therapy is best for both your medical and insurance needs.
Prior Authorization: If your doctor thinks you need a certain medication not on your health insurance plan's formulary, they may request an exception by contacting your insurance company. Sometimes, your doctor may not realize that a prior authorization is required. Pharmacies, along with insurance companies, cannot change therapies without consent from the prescribing physician. If you receive a different medication, you may want to ask your pharmacist if you could get the medication your doctor selected if you obtained a prior authorization. If the answer is yes, you may want to place a call to your doctor requesting that he or she submit the appropriate paperwork so you can receive the medication your doctor prefers.
Consumer Savings Program: Consumer savings programs are offered by pharmaceutical companies to provide free or low-cost medications to people who cannot afford their medicine. For example, AstraZeneca, the maker of CRESTOR, offers a program where CRESTOR costs no more than $25 per month for eligible patients with commercial prescription drug coverage. That means that even if your commercial prescription drug coverage normally requires a co-pay of $30 or higher for branded medications like CRESTOR, if eligible, you can receive your CRESTOR prescription for no more than $25.
You can learn more at CRESTOR.com.
*Other restrictions may apply.
Patient Assistance Program: For patients who require further assistance with the cost of their medicines, pharmaceutical companies and the government provide patient assistance programs. AstraZeneca has one of the most generous patient assistance programs in the industry. In 2008 alone, AstraZeneca helped more than 440,000 patients fill 2.7 million prescriptions - at a savings of $612 million.
In short, if you have questions about your health insurance plan, contact your insurance company. The customer inquiry number is usually located on the back of your insurance card and most insurance carriers also include information on their Web sites.
About CRESTOR(R) (rosuvastatin calcium):
In adults, CRESTOR is prescribed along with diet for lowering high cholesterol. CRESTOR is also prescribed along with diet to slow the progression of atherosclerosis (the buildup of plaque in arteries) as part of a treatment plan to lower cholesterol to goal. CRESTOR has not been approved to prevent heart disease, heart attacks, or strokes.
For more information about CRESTOR, including full Prescribing Information, visit www.CRESTOR.com
IMPORTANT SAFETY INFORMATION:
CRESTOR is not right for everyone, including anyone who has previously had an allergic reaction to CRESTOR, anyone with liver problems, or women who are nursing, pregnant, or who may become pregnant.
Your doctor will do blood tests before and during treatment with CRESTOR to monitor your liver function.
Unexplained muscle pain and weakness could be a sign of a rare but serious side effect and should be reported to your doctor right away.
The 40-mg dose of CRESTOR is only for patients who do not reach goal on 20 mg.
Be sure to tell your doctor if you are taking any medications.
Side effects: The most common side effects are headache, muscle aches, abdominal pain, weakness, and nausea.
For more information about CRESTOR, including full Prescribing Information, visit www.CRESTOR.com.
About AstraZeneca:
AstraZeneca is engaged in the research, development, manufacturing and marketing of meaningful prescription medicines and in the supply of healthcare services. AstraZeneca is one of the world's leading pharmaceutical companies with global health care sales of $31.6 billion and is a leader in gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and infectious disease medicines. In the United States, AstraZeneca is a $13.5 billion dollar healthcare business.
For more information about AstraZeneca in the US or our AZ&Me(TM) Prescription Savings programs, please visit: www.astrazeneca-us.com.
EDITOR'S NOTE:
Data in the article is from the following sources:
1. Tufts Health Plan. Automated Review of Step Therapy Medications. Available at http://www.tuftshealthplan.com/providers/provider.php?sec=news&content=auto_rvw_step.
Accessed July 10, 2009.
2. American Pain Foundation. Position Statement on Step Therapy and Therapeutic Switching. Available at http://www.painfoundation.org/PositionStatements/StepTherapyandTherapeuticSwitching.pdf. Accessed July 10, 2009.
3. Prescribing Information for CRESTOR. AstraZeneca Pharmaceuticals LP, Wilmington, DE.
4. Healthcare Coverage Glossary. Blue Cross Blue Shield. Available at http://www.bcbs.com/coverage/glossary. Accessed June 2009.
5. Fingertip Formulary. Data accessed: Percentage of covered lives - Medicare Part D. Accessed August 17, 2009. **Defined as Tier 1 through Tier 7 on Medicare MA, Medicare PDP, and Medicare SN by Fingertip Formulary as of January 2009. Data include covered lives whose prescriptions may be subject to step therapy requirements.
6. Fingertip Formulary. Data accessed: State Medicaid Plans. Accessed August 17, 2009.
7. 'AstraZeneca helped more than 440,000 patients save $612 million on medicines in 2008." AstraZeneca approved Corporate news release. February 10, 2009. http://www.astrazeneca-us.com/about-astrazeneca-us/newsroom/corporate/4810750?itemId=4810750 Accessed July 16, 2009.
Courtesy of ARAcontent
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