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5 Tips to Managing Your Insurance Coverage

March 26, 2013 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

Don’t use providers that aren’t in your network. Most plans have lowered how much they will pay for doctors or facilities not in your network, while some won’t pay for out-of-network providers at all.

Review how prescriptions are reimbursed under your coverage. Many plans are now offering reimbursement based on a percentage of the retail cost of a drug, which can add up quickly. If you pay a percentage instead of a co-pay, compare prices at different pharmacies.

Prepare for a doctor visit ahead of time if you anticipate a prescription, diagnosis or treatment plan. You should have your benefits summary with you as well as your drug formulary to know how much you’ll pay for a prescription before you leave the office. You can also pull up prices at local facilities on your tablet or phone at www.medtipster.com to discuss choices with your doctor.

Read your benefits summary carefully to know what’s in your plan, and what isn’t.

Shop for the lowest priced facility for diagnostic tests. Hospital-based services are often priced higher than independent facilities.

 

Drug Adherence Rises When Co-Pays Go Down

September 14, 2012 By: Nadia Category: HealthCare, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: Reuters Health, by Amy Norton – 9.11.2012

When people with chronic health conditions have lower out-of-pocket costs for medications, they are more likely to actually fill their prescriptions, according to a new research review.

The findings, reported in the Annals of Internal Medicine, sound logical. But they lend some hard numbers to the idea that lower drug costs should improve people’s adherence to their medication regimens.

“It was striking to us,” said lead researcher Meera Viswanathan, of RTI International, a Durham, North Carolina-based research institute.

“If you help people with costs, even a little, it seems to improve adherence,” Viswanathan said in an interview.

She and her colleagues reviewed several dozen U.S. studies on various efforts to improve people’s ability to stick with their prescriptions. A few of those studies focused on insurance coverage – either giving people drug coverage or lowering their out-of-pocket costs for prescriptions.

Some looked at what happened after Medicare prescription coverage took effect in 2006; others looked at cutting out-of-pocket payments for people with private insurance.

Overall, better coverage seemed to help. In a study of nearly 6,000 heart attack patients, for example, those given full drug coverage through their insurer got more prescriptions filled over about a year.

Of patients who were on their usual insurance, 36 percent to 49 percent filled their prescriptions, depending on the medication. Those rates were four to six percentage points higher among people with full drug coverage.

Patients with full coverage also suffered a new complication, like a stroke or second heart attack, at a slightly lower rate: 11 percent, versus just under 13 percent.

But while there is some evidence of actual health benefits, not many studies have followed people long-term to see if the better drug adherence translates into a longer or healthier life.

“There were some encouraging findings,” Viswanathan said. But more research is needed to know what the long-term health effects are, she and her colleagues write.

The results do not mean that better drug coverage is the only way to get people to fill their prescriptions, according to Viswanathan.

The studies in the review found some other tactics to work, too. Education plus “behavioral support” was one.

That goes beyond telling patients about their health problem, and why a particular medication is needed, Viswanathan said. “You would also try to get through the barriers that may keep a patient from taking it,” she said.

If a patient was afraid of side effects, for example, a nurse might discuss that with him or her.

Another measure that seemed effective was “case management.” That means the health provider would try to identify patients at high risk of not using their prescriptions, then follow-up with them – with phone calls, for instance.

It’s not clear, Viswanathan said, how programs like that could be “scaled up” to be widely used in everyday practice, and not just clinical trials.

And the specific fixes might differ depending on the health problem. With high blood pressure, a fairly simple move seemed to boost patients’ adherence to their medication: Giving prescriptions in blister packs rather than bottles, so people could more easily keep track of whether they’d taken their daily dose.

With more complex measures, the question of how to work them into the real world remains. “We need to know, what does it take to implement them into clinical practice?” Viswanathan said.

Figuring out how to get people to stick with their medications is considered a key part of improving healthcare. Studies show that 20 percent to 30 percent of prescriptions are never filled, and half of medications people take for chronic ills are not taken correctly.

All of that is thought to contribute to 125,000 deaths a year, and to cost the U.S. healthcare system as much as $289 billion annually.

June 11, 2010 By: Jason A. Klein Category: HealthCare, Medtipster, Prescription News, Prescription Savings

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