January 2019 — It’s a new year…so that means reimbursement challenges aplenty for all of us! In addition to narrowed formularies and increased tiers for high-priced medications, many patients will also be faced with Accumulator Adjustment Programs. This means they will be required to meet their out-of-pocket minimum in addition to whatever a manufacturer’s co-pay assistance program may have already paid. This will have a significant impact on patients and their families, since it is a financial burden they may not have faced in the past.
We will be carefully reviewing all patients’ medical plans before their first factor orders in January/February. However, to help assure uninterrupted service, let’s work together on the following:
- Please alert us to any insurance changes for patients on service with your 340B Outpatient Factor Program.
- Remind patients to look for new insurance cards in the mail and to update their pharmacy as well. This allows us to confirm benefits before they need an order.
- Let’s continue to help every patient sign up or renew their Manufacturer Co-Pay Assistance Program.
- To help patients understand their options, you may want to direct them to educational and advocacy resources available through NHF and local foundations. Here is a brief video from Alliance for Patient Access: The Co-Pay Surprise.