By Franklin Delgado
Health insurance plans often do not cover certain medications, which can result in high costs for patients. This situation may originate from the low frequency of use of the medication, the availability of generic alternatives or knowledgeable decisions about cheaper medications.
In this regard, the GoodRX platform explains what you can do to save on your prescription medications that are not covered by insurance, keys collected by Newsweek to collaborate with the patients’ pockets.
Available alternatives
Consult with a health professional
- Many professionals may not be aware of the details of drug coverage. It is essential to discuss generic or biosimilar alternatives with your doctor.
- 90-day prescriptions can be requested, free samples requested, or dosage reduction discussed to save costs.
- Ask your doctor if you can cut a high-dose pill in half to save money.
- Request free samples of the medication.
Request an exception to the prescription knowledge
- The insurer may be asked to evaluate the inclusion of the drug in the coverage list. This may require a letter from the doctor explaining the need for the medication.
- Previous steps, such as trying alternative medications, must be taken before getting an exception.
- Some plans will require step therapy before approving your exception. Step therapy is a type of prior authorization that requires that you: a) Try a less expensive medication that is included on the knowing formulary; b) You show that it is not effective or that it has side effects; and finally c) Go to the pharmacological treatment you are requesting.
Patient Assistance Programs
There are several programs, including patient assistance programs and manufacturer copayment programs, that can help reduce uncovered drug costs.
Companies like AstraZeneca, Johnson & Johnson, Lilly, and Merck offer financial help for specific medications.
Insurance Options Review
During enrollment periods, patients should consider switching to an insurance plan that includes coverage of their necessary medications.
It is advisable to use tools such as the Medicare Belief Finder to find plans that offer the required coverage.
Generic and biosimilar medications
The generic drugs and the biosimilars They are cheaper versions of brand-name medications, but they differ in their composition, complexity and the degree of savings they can offer you.
- Generic: Has the same active molecule, dose and route of administration than the reference (brand) medicine, and must demonstrate bioequivalence through more basic clinical studies. It is a compound of chemical synthesisrelatively simple to manufacture.
- Biosimilar: It is a very similar copy of a biological medicine (made from living cells), with the same indication, efficacy and safety than the long-established, but is not chemically identical; It has small controlled structural variations.
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