As we enter 2012, many patients will be changing to new insurance plans.
And for a few, deductibles will be rising.
One thing that’s emphasized in the Affordable Care Act, however, is that preventive services would remain “free.”
However, consider this story of a man, who thought he wouldn’t have to pay for his screening colonoscopy, instead was charged over $1,000 for the procedure.
From USA Today,
Bill Dunphy thought his colonoscopy would be free.
His insurance company told him it would be covered 100 percent, with no copayment from him and no charge against his deductible. The nation’s 1-year-old health law requires most insurance plans to cover all costs for preventive care including colon cancer screening. So Dunphy had the procedure in April.
Then the bill arrived: $1,100.
The reason? During the procedure, polyps were found and rightfully removed. But in doing so, it changed the colonoscopy from a screening procedure to a diagnostic procedure, thus making it applicable to the patient’s deductible.
Such semantics are important, as insurance companies will seize them at every opportunity to pass on costs to both patients and hospitals….
- Preventive care: It’s free, except when it’s not (goerie.com)
- Preventive care: It’s free, except when it’s not (usatoday.com)
- Loophole in U.S. law means not all preventive care free (ctv.ca)
- Preventive care: It’s free, except when it’s not (sfgate.com)
- Preventive care: It’s free, except when it’s not (seattlepi.com)
- Preventive Care Is Free — Except For When It’s Not (huffingtonpost.com)
- Preventive Care: It’s Free, Except When It’s Not (maboulette.wordpress.com)
- Preventive care: It’s free, except when it’s not (mysanantonio.com)
- Preventive care: It’s free, except when it’s not (seattletimes.nwsource.com)
- Know What to Expect From Colonoscopy Prep (everydayhealth.com)
You have insurance and, supposedly, it covers your medicines. However, you still get stuck with a portion of the bill that the insurance company calls a “copay.” In some cases these copays can run more than $150/ month per medication (e.g. Enbrel). If you are on more than one of these expensive, branded medications the copays can really add up. What are your options?
1. Generic alternative. Always ask your doc if there is a reasonable generic alternative. This is always the best option for you in the long run. However, if there truly is no generic medication that comes close, then check into either (or both) of the next two options.
2. Drug specific copay programs. These programs are run by the manufacturers of the drugs, aka Big Pharma (BP). Usually, these discounts are given to all patients, regardless of income. But make no mistake, it is a way for BP to circumvent your insurance company’s cost control mechanism for prescriptions. By picking up part or all of the cost of your copay, BP trying to make their product more attractive to you and to your physician. But when the manufacturer stops offering the copay discount programs you will be back to square one. However, if according to your doctor, you must be on one of these drugs, then by all means, take advantage of the savings while they last. In the case of Enbrel, the Enbrel Support Card Program picked up the tab for six months worth of copays. To find out more info on whether such a program exists for your medication, there are many websites out there, including the manufacturer’s site.
However, I found the following two websites particularly useful:
Internetdrugscoupons.com This website shows you all available drugs that have coupons, copay and otherwise, associated with them. It’s an ugly little site, and ignore the annoying ads for a prescription savings card. But it couldn’t be simpler to use. And all the coupons I clicked on were still valid- so it seems like the folks behind it keep it up to date. According to the mission statement on the website “[The founder] assembled this database of drug coupons to make it easy for people like my elderly parents to save money on their medications.”
RxAssist.org This is a super slick website that allows you to look up your medicines, albeit individually, to see what deals are offered. When you see a deal you click on the medicine and you are directed to the manufacturer’s website. According to the About section of the website, RxAssist.org was established in 1999 with funding from The Robert Wood Johnson Foundation.
3. Disease specific copay programs. There are many organizations that offer patients with specific diseases, such as cancer and HIV/AIDS, assistance with their prescription copays. These programs often require financial ability-to-pay information from you to qualify for assistance. Disease Specific Copay Programs is a very comprehensive list of copay and other assistance programs compiled by a BP-funded site called Partnership for Prescription Assistance, aka PPArx.org.
Leslie Ramirez is an internal medicine physician and founder of Leslie’s List, which provides information that enables all patients, but especially the uninsured and underinsured, to find more affordable medications and health care services.
- Copay Cards: Don’t Throw The Baby Out With The Bathwater (georgevanantwerp.com)
- Short Survey On Copay Cards (georgevanantwerp.com)
- Institute of Medicine Recommendations Released; Birth Control Could Become a Copay-Free Preventive Service (womenshealthnews.wordpress.com)
- Prescription Med Prices Set to Plummet (abcnews.go.com)