So, what’s going on here and what can you do to lower your monthly bill? Here are some reasons why you may be paying the full price of your asthma medication.
High-deductible health plans (HDHPs)
Every year, more people are on the hook for the full cost of their medications because of high-deductible health plans, those that require members to pay out of pocket for all of their medical expenses, prescriptions included, until they reach their deductible of sometimes $2000 or more. In fact, a recent report revealed that over 40% of people under the age of 65 are currently enrolled in a high-deductible plan, up 72% since 2010.
If you have a high-deductible plan, it’s likely you’ll have some sticker shock at the pharmacy counter, especially if you’re picking up an expensive inhaler like Breo Ellipta or Symbicort, which have monthly cash prices of well beyond $500.
Coverage restrictions like prior authorizations, step therapy, and quantity limits can be tricky. These policies mean that your medication is still covered, but you will need to jump through some hoops before your plan will pay for your medication.
A prior authorization is when a plan needs to approve a non-preferred medication before they will cover its cost. In most cases, your doctor will need to show that your drug is medically necessary before you receive coverage. Asthma inhalers like Breo Ellipta and Dulera require a prior authorization, so be prepared to wait a couple days for approval before your insurance will cover your inhaler.
Step therapy is a type of insurance restriction where your plan requires you to try lower cost alternatives before they will cover the drug prescribed by your doctor. For instance, in the case of Arnuity Ellipta, you may have to prove that inhalers Asmanex or Qvar don’t work for you, and in the case of Breo Ellipta, you may have to show that Symbicort doesn’t work for you.
A quantity limit is when your plan will only cover a certain amount of your drug for a specific time period. With asthma medications, many plans will only cover one inhaler per month, and you will need to pay the full cash price (as much as $500 in many cases) for any subsequent inhalers. Many people face this restriction when they lose their prescription, need an early fill, or are going on a long vacation.
Regardless of high deductibles and coverage restrictions, here are some tips to help you save on expensive asthma inhalers.
Savings Tip #1: Ditch your insurance
In many cases, you can get a better price by not using your insurance at all. GoodRx provides discounts and coupons on prescription medications, which, can lower your out-of-pocket cost, especially when you’re stuck with a big deductible.
Savings Tip #2: Use your Health Savings Account (if you have one)
If you have a plan with a high deductible, you may want to considering enrolling in a Health Savings Account (HSA) that you or your employer can pay into. You can use the funds from your HSA on qualified medical expenses (see the full list here), including prescriptions purchased using a discount card. For more background on what an HSA is and how they work, take a look at this article.
Savings Tip #3: Ask your doctor about alternatives
There are multiple inhalers on the market today. Talk to your doctor to see if any alternative medications are covered by your insurance and work for you.
Savings Tip #4: Use a manufacturer copay card or patient assistance program
Many manufacturers of brand-name drugs offer savings programs to help eligible patients save on their medications. Search for your drug on www.goodrx.com and click the “Savings Tips” tab on the left to see available savings options.
Savings Tip #5: Keep your eyes out for a generic
Generic drugs are usually cheaper than the brand-name version.
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