Demystifying the Medication Access Process_Q&A

0:00
0:29 Will your pharmacist automatically give you a generic version of a drug? What if you specifically want the brand version?
1:33 Is there a difference as far as the insurance company is concerned with a med that needs prior authorization vs. one that is considered excluded?
3:00 I’m confused about how the co-pay card works. Does it cover the cost of the medication except for the co-pay?
3:53 How long does it take to go through the appeal process for a denied medication?
5:08 Can you talk about Medicare, and they don’t provide co-pay cards. Will that process change?
6:35 If you have an issue with a generic medication and the allowed fillers seem to be a prob with one generic vs another. How can you go back to a specific manufacturer?
7:54 How do you find out BEFORE selecting Medicare pharma plan which plans cover monoclonal antibodies such as Actemra for GCA?
8:46 Is Rituxan only administered by infusion center only, or can it be done via home infusion?
9:23 How hard is it to stay with the original biologic if a biosimilar is available? Having taken the original successfully and without side-effects, I don't want to take the additional risk of another "similar" biologic infusion.
10:49 My doctor is looking at a weight loss med because I am so stuck with the prednisone impact! With high BP and other issues, I need to lose weight. My insurance is not covering basically any of them (since I don’t have diabetes). What options do I have since this is still a direct medical issue?
12:42 Is Rachael aware of patient assistance programs where the drug maker may offer discounted cost on their medications?
13:51 Some of the medications we’re taking are done by self-administering by a shot. What can we do that we get proper instruction in how to do this procedure?
16:31 If you get coverage for a drug like Rituxan, but it turns out not to have been as effective as hoped, is it harder to get covered the next time?
17:57 I was prior authorized for Tavneos by my pharmacy. but the co-pay was still expensive. The specialty pharmacy tried getting patient assistance. I was denied assistance as they said my diagnosis (EGPA) was not approved by the FDA. I was surprised that my pharmacy approved it, but the company refused it.
19:51 Can you talk about how the pharmacy benefit managers impact the system? The cost seems to change all the time.
22:07 Can an insurance company stop covering a drug like Actemra even if they had a one-year authorization approved?
24:33 I've been denied coverage for mycophenolate sodium for treatment of my MPA. I've gone through three appeals (physician letters provided) and Medicare/BCBS supplemental insurance denies coverage as the drug is not FDA approved for my condition. Any suggestions?
Demystifying the Medication Access Process

Recorded December 2023