PHA Case Study – Life-saving drug not covered

Situation:

Frank, a diabetic, had a costly mix-up in his insulin prescription. He expected the prescription to be the newer, penbased prefilled cartridge injection system, on which his physician instructed him during his office visit. However, the physician had not specified cartridges and the pharmacy benefit management service (PBM) sent Frank traditional, more costly insulin vials, which he unsuccessfully tried to exchange. The Personal Health Advocate provided documentation from the patient’s physician that he wanted pre-filled cartridges and the PBM agreed to the exchange, saving both Frank and his self-funded employer money.

 

What The Healthcare Survival Guide says:

It’s possible never to pay full price for your medications. Whenever possible, ask your doctor if you can substitute your brand-name medications for generics, which generally cost 20 to 80 percent less than their name-brand counterparts (pg. 47). Look for discounts—or free offers—for medications. Pharmaceutical companies offer a free trial of your medications through their websites (pg. 49).

If you would like a free copy of The Healthcare Survival Guide: Cost-Saving Options for the Suddenly Unemployed and Anyone Else Who Wants to Save Money, you can download it at www.healthcaresurvivalguide.com.

 

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