​   A couple of weeks ago, I was prescribed a new medication... that had a
   hefty price tag! My first question was “what’s the cash price?” When that wasn’t
   any cheaper,  I checked with the pharmacy tech about the coupon from the drug
   manufacturer’s website (apologies to everyone behind me in line at my
   local pharmacy). I ended up leaving the prescription at the pharmacy and
​   went home to look into more options.

What can you do to lower your prescription costs if a medication you need isn’t covered by your health insurance?​

1. As I mentioned above, ask if the cash price is cheaper. Sometimes you can get a better price if you don’t use your insurance. Seems counter-intuitive but it’s true.
2. Check your health insurance formulary (list of prescription drugs that are covered by your insurance plan) to see what alternative options you have, including generics or similar drugs. Share that list with your doctor and discuss whether any of the other drugs are a good option for you.
3. Ask your health insurance plan to make an exception. This requires some effort from you and your doctor but you can ask your health insurance plan to cover your medication even if it’s not on the formulary. You can learn more about the exceptions process for private insurance here. Medicare has an exceptions process as well.
4. Look into prescription assistance programs. There are non-profit organizations, pharmaceutical manufacturers (check their websites), and state and local government programs that can provide financial assistance with paying for prescriptions; many programs are not based on income.  Some websites compare prices and offer coupons. Here are a few you can look into:
   1. GoodRx.com - GoodRx finds and compares prices for every FDA-approved prescription drug at over 70,000 pharmacies nationwide. There can be substantial variation in price. You can also find coupons on the site or mobile app as well as get a GoodRx discount card.
   2. NeedyMeds.org - NeedyMeds provides information on how you can obtain assistance in paying for your medications. Search by medication name and find out if there are coupons, rebates, or financial assistance programs from the drug manufacturer. NeedyMeds also has a drug discount card. 
   3. Partnership for Prescription Assistance - PPA is another program that can help you find out what prescription assistance resources you may be eligible for.
   4. Medicare Extra Help - If you’re on Medicare and having limited resources, you may qualify for the Medicare Extra Help program which helps pay the premiums, deductibles and co-pays associated with prescription drug plans.

5. Other options include going to a big box store, using a mail-order pharmacy or getting a larger supply.

​So, what did I do about my medication? Well, in my case, the GoodRx price was only a few dollars less, there were no substantive coupons available for this particular medication, and the pharmaceutical assistance program was income-based. My doctor gave me free samples while we work together to request an exception from my health insurer. It’s a long shot but it’s worth a try because if you don’t ask, then the answer is definitely no. 

 
This may seem a little old-fashioned, but many patient advocates recommend taking the time to create a Health Information Binder. You’re already thinking “but everything is in my electronic health record” or “I keep that information in my phone.”  Here are some reasons it’s helpful to have a binder as well:

1. You may be in a hospital that’s not your usual hospital/health system. The electronic health record (EHR) systems should be able to “talk” to each other, but sometimes that doesn’t work so well. 
2. Does your phone have a passcode? If you’re not able to communicate, how will someone get in it to look for your important health information? What if you don't have your phone with you?
3. The binder can have more information than is kept in your EHR - for example, list of emergency contacts, updated advance directives, your own summary of your health history and current health status.

What should you put in your Health Information Binder?

• ​Personal and health information - such as date of birth, allergies, emergency contacts, and more
• Health insurance information - policy number, insurance company phone number, website/login information
• Medication list - name of medication, what is it for, dosages, schedule, pharmacy name and number. 
• List of health care providers - name, contact info
• Summary of medical history/health status - what are you currently being treated for, past illnesses/surgeries, family history
• Copies of recent and important test results
• Advance directives - health care power of attorney, living will/POLST, DNR order
• CampaignZERO: Families for Patient Safety checklists for hospital safety
• Notebook or note paper and pens to write: 
  • questions you want to ask
  • answers to your questions
  • instructions from providers 
  • medications prescribed or stopped    
  • tests ordered, results, next steps
  • lists/notes for post-appointment or post-hospital discharge plans and needs

Make sure your emergency contacts know where you keep your binder in case someone needs to bring it to the hospital.

Find a template here.

It’s the season… for open enrollment. Whether it’s Medicare, the Health Insurance Marketplace, or some employers, fall is when many people can switch health plans for the coming calendar year.  Do you have all the information you need to make informed decisions during open enrollment?

​SCROLL DOWN to see the article about key health insurance terms.

​Below are links to helpful resources about open enrollment:​

How many of us really understand health insurance? Have you read your health insurance policy? (Sounds fun, right?) I’m highlighting a few key terms below; you can also look at this helpful glossary to better understand your
health plan.

• Premium - the amount you pay, usually each month, for your health insurance plan.

 

• Deductible - the amount you have to pay for services before your health insurance plan begins to pay for covered services.

 

• Copayment - a fixed amount that you have to pay for a covered service. For example, it’s common to pay a set amount (e.g., $25) when you see a physician.

 

• Co-insurance - a percentage of the allowed amount billed for a covered service. For example, if the physician bills $100 for a visit and your co-insurance is 20%, you would owe $20.

 

• Network - the providers and facilities that your health insurance plan has contracted with to provide care. Usually, it is more expensive for you to receive services from an out-of-network provider than an in-network provider.

 

• Out-of-pocket limit - the maximum amount of costs you pay for covered health care services. Premiums do not count toward the out-of-pocket limit. Your deductibles, co-pays, co-insurance, out-of-network costs, and other expenses may or may not count; be sure to understand how your health plan counts out-of-pocket costs and what the maximum is. Some plans do not have an out-of-pocket limit for out-of-network services.

 

• Excluded services - services that are not covered by your health insurance plan.  
  • Medicare excludes dental, routine vision, hearing aids, long term care, and other services, although some private Medicare plans may cover some of these services. See what Medicare covers here. 
  • Private/employer plans - excluded services will vary by plan. Be sure to understand what services are and are not covered by any plan you are choosing, especially if it’s a service you think you will need (e.g., infertility treatments, long-term care, etc).

And then there are allowed amounts, balance billing, and so much more. Read the policy benefits booklet carefully. Be sure you understand what services are covered, when you need to obtain prior authorization or get a referral before seeing a specialist, and that just because your physician is in-network, it doesn’t mean that the hospital he or she may treat you at is also in-network. 

Bottom line: the more you know in advance about your health insurance plan, the better prepared you can be to obtain the care you need as well as manage your financial risk.

1. Communication, Communication, Communication. As with just about everything in life, most issues that cause problems in the adult-children-aging-parents relationship can be alleviated by early, direct, and empathetic communication. Have the difficult conversations with your parents before there’s a crisis; these include discussions about aging in place versus moving to a senior housing facility as well as end-of-life planning. You can think of it as payback for when your parents had to explain the-birds-and-the-bees to you… but don’t forget that your aging parents are adults and need to be treated that way. Also, try to put yourself in their shoes and understand why they may be resistant to what you consider to be helpful advice.

2. Fill out Advance Directives (health care power of attorney (HCPOA), living will, financial power of attorney). I recently was on a conference call with the adult children of a woman who was critically ill in a hospital in another part of the country. None of them knew if she had designated a HCPOA or had completed a living will. According to The Conversation Project, “82% of people say it’s important to put their wishes in writing but only 23% have actually done so.” It really is a gift to yourself as well as to those you love to make your wishes known and designate someone to carry them out for you. My website has some links to end-of-life planning information. You can fill out these forms yourself or a professional can help you. Be sure to designate a financial power of attorney as well.

3. Share information. Building off of the communication advice, it’s also a good idea to share important information with whoever is your designated HCPOA as well as with others who are close to you. It’s hard to be truly helpful if you don’t have the information you need. If you are or may be caring for aging parents, try to have the following information about them:

• insurance cards and policy coverage details
• names and contact information of health care providers
• log-in information for electronic health records
• pertinent medical info, including medications, recent test results, summary of health problems
• If you live out of town, contact information for close friends and neighbors they may call in an emergency (and make sure those people have your contact information too)

All of this information can be kept in a personal health information binder; the pages can be scanned and emailed to you, or you can make hard copies. More information as well as a template for a personal health information binder can be found here.

4. Practice self-care. If you are taking on a lot of caregiving duties, be sure to take care of yourself. As the flight attendants explain at the beginning of every flight, “put on your own oxygen mask before helping others.” Take time for yourself so that you can have the patience and energy to be there for your family members who need you.

5. Consider professional help. Clearly, it’s difficult caring for aging parents who don’t live nearby. But even if you live in the same city, juggling work, raising children, and caring for aging parents all at the same time is a challenge. A private patient advocate can help in these situations. A trusted patient advocate can accompany people to doctor appointments - including preparing for and following up after the appointments; help smooth transitions between hospital, rehab facility, and home; find resources to help keep older adults in their home; research treatment options; and be a calm voice of experience in an otherwise stressful situation. 

Bottom line: planning ahead, talking to each other, and taking care of yourself can make caring for aging parents less stressful and more rewarding for everyone involved.

Resources:

• To download or order a free paper copy of a booklet on Caregiving from the National Institute on Aging - https://www.nia.nih.gov/health/caregiving
• AARP Prepare to Care: A Caregiving Planning Guide for Families
• Family Caregiver Alliance