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Are Your Patients Getting All the Financial Support They Deserve?
- September 02, 2021
- Amber Specialty Pharmacy
It might sound obvious but here’s the thing: patients who take their prescribed medications feel better. Patients who don’t take their prescribed medications are at a higher risk for being hospitalized. And the number one reason patients don’t take their meds the way they should? High copays and devastating out-of-pocket costs.
The medications prescribed to treat chronic conditions often come with large price tags. That’s why finding financial assistance is essential for those patients.
So where do you start? How much time does the staff in a busy doctor’s office have to dig through piles of paperwork and research to find financial help for their patients? And who can help?
Medical or Pharmacy Benefits: Which is Better for a Patient?
When you send us a referral, every patient receives a complete benefits investigation. Our intake team looks at both a patient’s medical benefits and their pharmacy benefits. This helps us learn which billing process would be best for the patient.
Some medications can be billed to the medical side of a policy. In that case, if a patient has met their deductible, the monthly cost of the medication could be very low. If a medication has to be billed through the pharmacy benefits, the monthly copays could be quite high. It all depends on how the policy classifies the medication. Copays could be anywhere from $1 to hundreds of dollars.
Your Patient Has a High Deductible or High Copay – Now What?
If the patient has a high deductible, it’s important to note when a plan resets. Paying a deductible can change a patient’s financial outlook. However, patient assistance may be available to help those patients. We monitor each patient’s policy closely. If needed, our team quickly researches patient assistance programs for qualifying patients.
Sometimes, patients qualify for copay card programs. The makers of the drug often have programs that can lower or eliminate a patient’s copay. We monitor the spending limits of copay cards to ensure the cards last as long as possible. Most copay cards expire after one year, but patients can reapply for the new year.
What if General Assistance Isn’t Available?
Think about all the different types of cancer. There is general help available for a cancer diagnoses. There is also help for specific cancers. For example: Leukemia; Colorectal Cancer; Head and Neck Cancer; Lung Cancer; Skin Cancers and many more, all have their own funds. Amber Specialty Pharmacy monitors all options that are diagnosis specific. Doing this increases the chance financial support can be found for patients.
Other chronic conditions also have help available for patients. To name a few: Heart Failure; Lupus; Transplant (categorized by organ); and many more. An exact diagnosis can be the key to finding available, lesser known financial help.
Staying on top of all assistance options is critical for patients who have a Rare diagnosis. The smaller number of patients can limit the availability of financial help. The same can be said about a new drug. Insurance companies often don’t have the new drug added to their system. This can leave patients without coverage for a life-changing medication. Having an advocate in your corner means no stone is left unturned when it comes to finding financial support.
Last year, our team of Intake and Financial Assistance Specialists saved patients $40 million dollars. That includes over $35 million in savings from copay cards, grants and foundations. An additional $5 million was saved with proper medical billing procedures.
Our team monitors financial resources daily. It’s part of our promise to getting patients on therapy as soon as possible. Removing financial stress leads to better, healthier outcomes.
Learn more about insurance and financial assistance here — reach out to our team to see how we can help today.