June 29, 2010

Is Your Copay Suddenly Too High For Your Medicines?

Posted in Heart disease tips tagged , , , , , , at 2:19 am by keepyourhearthealthy

The diagnosis of heart disease means a continual risk for heart attacks which is why heart patients need to take  a handful of pills everyday.  There’s usually several pills needed for blood pressure, cholesterol and keeping the blood thin in order to reduce your risk as much as possible.  Of course, all of these medicines cost money.  Even with insurance the cost can be quite overwhelming!

I listed some of the solutions to finding cheaper medicines in my book What To Do When You Have Heart Disease.  In some cases though, you may find that the price of your copay has changed suddenly.  Insurance companies frequently cover prescriptions on a Tier system.  For example, Zocor may be covered on your plan with a copay of $20 because it is listed in Tier 2.  Then suddenly the insurance company moves it up to a Tier 3 and it costs you $30 instead!  There may be no obvious reason or warning for the Tier change.  If the price becomes too much, you may have to work with your doctor to find an alternative prescription on a lower Tier.  Or, if there is no acceptable substitute, you can ask your doctor’s office to fill out a form for a “Tier Exception.”  This means that you are appealing to the insurance company for a lower Tier price.

I found a great post from a pharmacist that explains the Tier system and how to deal with sticker shock at this link: Pharmacist Blog.

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