7 Questions to Ask Your Insurance Provider
- by Karen S.
- May 11, 2018
Karen S. has been compensated by Teva Pharmaceuticals USA, Inc.
Dr. Barry Singer, MD said it best: “whether you’ve been living with multiple sclerosis for a while or are newly diagnosed, it’s always a good idea to be your own advocate.” One way to be a self-advocate is to ensure you have affordable access to your prescribed relapsing MS (RMS) therapy. When living with RMS, these questions may be helpful to ask an insurance carrier before or after selecting a new plan.
- Is Teva’s COPAXONE® (glatiramer acetate injection) on the formulary? A drug formulary is a list of prescription drugs, both generic and brand name, that the plan covers. Make sure your RMS medication is on the list
- What is the difference between a co-pay and coinsurance? A co-pay is a flat fee, while coinsurance is a percentage of the cost of the drug after the deductible has been met that you may owe.
- What is the deductible (DED) and maximum out of pocket (MOOP)? The DED is the yearly amount your insurance states you must pay before medical coverage begins. Your MOOP is the maximum amount an individual must pay out of their own pocket which can include the DED.
- Is prior authorization required? This is the process to authorize member eligibility, benefit coverage and the medical necessity of the prescribed RMS medication. This is initiated by a pharmacy and completed by your doctor.
- Do you accept co-pay assistance from a manufacturer? If you have a coupon or co-pay assistance through your RMS therapy manufacturer, ask your insurance provider if this will be applied to the DED/MOOP.
- Are there product fees? If Teva’s COPAXONE® and a generic are both on the formulary, ask if there will be an additional fee to get the branded product. Also find out if you will pay the cost difference between the brand and the generic, and then see if that fee or cost difference be applied to MOOP.
- Will my local pharmacy fill my prescription? Generally, local pharmacies are unable to dispense certain medications due to cost and special handling; therefore, a specialty pharmacy will be contracted with your insurance plan. Specialty pharmacies can work with you in a variety of ways and provide education on your RMS medication.
If you have additional questions about your insurance, call Teva’s Benefits Specialists at 1-800-887-8100. They are strongly committed to helping patients find affordable access to COPAXONE®.
Knowledge is power. Having these questions answered can empower you, prepare you for additional costs, and could help provide information about the coverage necessary for your RMS medication.
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Shared Solutions® Benefits Specialist
About The Author
Karen S. is a Benefits Specialist with Teva’s Shared Solutions®. She has specialized in multiple sclerosis, is a point of contact for numerous Multiple Sclerosis Centers and has over 8 years of insurance verification and customer service experience.