Where is the love?

Healthcare has been a hot button issue lately here in the states. Of course for those of us who live with a chronic illness, it has always been an issue. But with the 2016 election, healthcare along with many other public policies have come to the forefront of the nationwide conversation. And frankly, the conversations have been quite alarming.

There is an overwhelming population of people who believe that healthcare has to be earned. That the right to live is not an inherent right for all humans (even though our US Constitution specifically states otherwise). People feel that if you work hard, pay your dues, and play by the rules, you will A: Stay healthy, and B: Be granted great insurance coverage, God forbid anything should happen to you. This logic is flawed. Chronic and/or acute health issues can happen to anyone, at anytime, for a variety of reasons. As a species, humans don't like to believe this. It creates what's called "cognitive dissonance," which is when we are presented with a reality that doesn't match up with what we've always believed. It therefore causes dissonance, or disruption, so we do everything in our power to ignore the reality and continue on with our faulty beliefs. We cannot reconcile reality with our wishes because it causes discomfort.

Most people grow up hoping or believing that they will have good health. This is normal - it's a positive outlook on life. However, as we grow older we tend to experience certain realities - maybe we're diagnosed with type 1 diabetes, someone we love is in an accident, our parent gets laid off and we almost lose our insurance - and we are able to shift our beliefs accordingly to read more like this: things may not always be easy. Things could happen to us and our family. But for some people, this adjustment doesn't happen. They continue to believe that bad things come to those who deserve it and that healthcare should be earned.

So is the issue that people are inherently bad and have complete disregard for others? I hope not. No, what I think is happening in the majority of cases is that people are simply rigid in their beliefs due to concerns about their own self-preservation. And this needs to change. We need to challenge our beliefs because they are flawed. Yes, it is a frightening reality to accept - that we could be struck with an illness or hit by a car at any time. But we are doing more harm than good by holding on to the flawed belief that we are in total and complete control of our health or our circumstances. It is not reality.

The reality is, every human has an inherent right to live. And for some humans, what they need to live - and live well - is a bit more extensive than what others need. So I challenge you all - what belief do you cling to that begrudges others their inherent rights? How can you start to chip away at that belief and re-frame it?

SOS!! Prescription Assistance Resources

Prescription medications. They play a huge role in the life of those with type 1. And they go beyond just medications - they include glucometers, test strips, lancets, pen caps, syringes, and so on. Many people with type 1 also live with autoimmune comorbidities, such as hyper/hypothyroidism or lupus, which means - you guessed it - more prescriptions. What many people don't realize is how costly these medically necessary medications and medical equipment can be, even after insurance coverage. For example, even with insurance coverage my co-payment for my insulin was roughly $230 for a 3-month supply. I am lucky. There are many people do not have insurance to soften the blow.

When you have type 1, getting your medical supplies can feel like a beast that you are expected to conquer all on your own, with no guidance. This may be why so many people fall between the cracks and struggle to care for their diabetes. Between living as a type 1 for almost 25 years and working in the field of medical social work, I have been privileged to glean handy information and resources that can help tackle this monster. Here is the quick and dirty handbook.

Terms to Know

Copayment. What you have to pay for your medication. 

Once your insurance pays their share (say, 80% of the cost of the medication), you are responsible for the balance (20%). Each insurance company is different in terms of how much they pay. Typically, insurance companies offer the most coverage for the cheapest medication, or the generic. As an example, your insurance may cover 80% of the cost of a generic (or formulary) medication, but 70% for a name brand (or non-formulary).

Formulary. The type of medication your insurance will provide the most coverage for. 

On the flip side, they will cover less (and you will pay more) for non-formulary or name brand. Then there are excluded medications/medical supplies - medications that your insurance company will not cover at all. However, if your medication is on the exclusion list, you may still be able to get coverage. 

Example: The insulin I use is on my insurance plan's exclusion list - meaning they do not cover it at all and I would be responsible to pay the entire price out of pocket. However, my insurance (and many others) allows my doctor to submit an appeal or letter of medical necessity for said medication. Once approved, the company agrees to cover the insulin as a non-formulary.
Get in touch with your insurance and ask what department can assist with this. It will likely be the prior authorization department.  If your doctor's letter/appeal is approved, your insurance may agree to cover this excluded medication to some extent- they won't cover as much as they would for a generic, but  they won't cover nothing.

Co-pay cards: Prescription assistance for commercial insurance - not for those who are on Medicare/Medicaid or uninsured. Co-pay cards can typically either be downloaded from the manufacturer website or given to you by your provider.
Prescription Assistance Programs: Programs that provide financial assistance/reimbursement for your out of pocket medication expenses. Typically those with Medicare or those who are uninsured are eligible. Applications can be made by mail or online, depending on the program.

Resources to Have

NeedyMeds. Probably my favorite resource when it comes to prescription assistance, NeedyMeds is a one-stop shop for assistance programs, downloadable coupons, and co-pay cards. Simply type in your prescription (you may need to know the generic name), and it will prompt you to choose co-pay card programs, assistance programs, or coupons, as they are available for that prescription. Link below:

http://www.needymeds.org/

Good RX. Another useful tool, Good RX provides a price comparison between your local pharmacies and downloadable coupons for your scripts. They have an app, or it can be used from your phone's browser or email. If you're old school, you can simply download the coupons and print them to take to the pharmacy. Link below:

https://www.goodrx.com/?kw=price&utm_source=bing&utm_medium=cpc&utm_term=goodrx|e&utm_campaign=Brand&utm_content=Ad-Group_GoodRx&msclkid=e01c282f134714ff51b9725fef046963

Whether you are uninsured, under-insured, or insured by a crappy plan, there are resources out there that can likely help. I encourage everyone to try out these resources. No one should have to pay exorbitant amounts of money to stay alive. Your doctor may be aware of other programs as well, so don't be afraid to ask them. You will likely need their help or their signature for some of the assistance applications. And this doesn't just go for type 1 - this goes for any and all prescriptions for any and all medical conditions.

Note: This post was written based on my experience, and is in no way an attempt at a thorough explanation of the ins and outs of insurance coverage. Each plan is different, and each person will have different experiences. Feel free to comment with different experiences or questions below.