There likely will be delays with processing the costs initially as your insurance company tries to figure everything out. Refill your modulator therapy as early in January as possible.For example, fill your modulator therapy on a Monday, your hypertonic saline on a Tuesday, and your Pulmozyme ® on a Wednesday, and so on. To avoid billing mistakes introduced by this confusion, consider filling your medications over multiple visits as opposed to one visit to the pharmacy. Pharmacies may be confused as they adjust to new insurance and copay assistance changes.And, if you can get a three-month supply in December, you absolutely should! Most plans allow you to fill medications about 7-10 days before you would run out, giving you the ability to refill a prescription approximately every three weeks. For the remainder of 2022, refill your modulator therapy as much as your insurance allows - give yourself a cushion for 2023 in the event of insurance delays brought on by copay adjustment programs.Consider picking up secondary insurance if you know your primary insurance is using a copay accumulator.įilling Your Prescriptions for the Remainder of 2022.If your insurance does NOT include a copay adjustment program, complete the Vertex attestation form.
If your insurance does include an accumulator copay adjustment program for the 2023 benefit year, you may be able to use direct reimbursement from Vertex GPS.
Contact Vertex GPS to begin exploring your options. Only move forward with this plan if you are confident that (1) the plan does NOT use a copay accumulator (2) your prescription costs will count toward deductible or (3) you can meet your deductible cost either through refilling medications with copay assistance or by paying out-of-pocket. Plans with higher premiums (the amount you pay each month for coverage) and lower deductibles (the amount you must reach before the insurance plan starts sharing costs) are likely better options because you will reach your deductible faster. If you are comfortable doing so, discuss your coverage options with your employer or benefits manager, and ask if there are different coverage plans that do not include an accumulator or maximizer program. (Note: Changes to Vertex’s copay assistance program do not affect those with Medicaid, Medicare, or Tricare insurance.) Search the coverage plan’s schedule of benefits or pharmacy limitations and exclusions for keywords such as “coupon,” “co-pay card,” “manufacturer," and "discount" to determine if there are any written restrictions for the co-pay assistance you may receive from the manufacturer co-pay assistance program. You can do this by asking your employer or benefits manager. Figure out if your health insurance has a copay accumulator or maximizer program. However, there are several tips to consider as you navigate the challenges that may come from the changes in the Vertex copay assistance program. I am sure it was the same in each local cystic fibrosis community across the country. When Vertex announced changes to its copay assistance program last month, many people were confused, afraid, and angry - both from the community and among the care team here at Johns Hopkins. Those who can declare that their insurance plans do not include an accumulator or maximizer program will continue to have the $8,950 per-fill program cap. Those with an accumulator or maximizer as part of their plan will receive copay assistance of only $3,500 per monthly fill (down from $8,950). 
Will be subjected to an annual copay assistance maximum of $20,000 (regardless of whether their plans include an accumulator or maximizer).Specifically, this means that people with cystic fibrosis: Vertex is changing the financial assistance offered through its Vertex GPS™ program which means that some people with cystic fibrosis who have insurance may have to pay more for their modulator therapies.
0 kommentar(er)
