For those people on a chronic drug therapy, choosing an insurance plan may mean different considerations and options then for those who are not on high priced therapies. Being aware of these options can save you money…maybe lots of money.
Are you on a routine drug therapy with a copay assistance program?
Most of the companies making high cost injectable and intravenous medications offer copay assistance programs to help patients pay for their out-of-pocket amounts (i.e. deductible, co-insurance, copays, cost sharing etc.). The copay assistance can cover most of the out-of-pocket amounts even for plans with very high deductibles and co-insurance fees. Most often, the higher the out-of-pocket amounts patients have on their plans, the lower the monthly premium they or their employers pay to the insurance company.
Because of the high costs of most chronic treatments, being on a routine drug therapy means the patient will easily meet the annual out-of-pocket amounts within the first few months of the plan year. If the drug manufacturer has a copay assistance program, and most do these days, the program will pay the patient’s provider for most if not all of the out-of-pocket amount, potentially leaving the patient to pay only a few hundred instead of a few thousand dollars.
Use Copay Assistance to Lower Your Premium
Knowing the out-pocket amounts will be covered by the drug copay assistance program means that a patient can choose a lower cost plan with a higher deductible and out-of-pocket amount, saving money on both ends. For example, if Plan 1 cost a person $700 per month and has a total out-of-pocket amount of $5000 and Plan 2 costs $500 per month but has a total out-of-pocket of $7500, choosing Plan 2 will save the person $200 per month ($2400 per year) with very little additional out-of-pocket costs to be met since the copay assistance program will pick up most of that patient responsibility, costing the patient very little over all.
The Devil is in the Details
It is important to know some facts do some checking before making a decision however:
- Does the drug you receive have a copay assistance program and if so, what is limit it will pay out? Does it cover only the out-of-pocket tied to the drug OR will it cover related treatment expenses such as the infusion room, supplies and services?
- Your deductible and out-of-pocket maximum combined should ideally not exceed the limit the copay assistance program will pay out.
- Do you anticipate needing any other expensive medical services or therapies during the first few months of your plan year? If you have surgeries, procedures or treatments prior to receiving your drug therapy (think about the “date of service”), then you will be responsible for the out-of-pocket amounts for those medical services before the drug copay assistance program kicks in.
- Enroll in the drug copay assistance program prior to or just after the new plan year begins AND well before you receive your drug therapy.
While receiving injectable or intravenous drug therapy for chronic conditions is not much fun, the drug copay assistance programs can work to the patients’ advantage by offering opportunities to find significant savings on insurance premiums and with your out-of-pocket amounts.
Big Sky IV Care Can Help!
Need more information about drug copay assistance programs and your therapy? We’re here to help!
Give us a call at Big Sky I.V. Care 406.752.0440
Dave Grady / Owner and President