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Prescription drugs 3 little known ways to save 

 March 29, 2021

By  Brian

Learn from Daphne and Phillip 3 little know ways to reduce or eliminate your prescription medication cost

Full Transcript

Good day, everybody. It's Brian Therrien here from the disability digest. And today we're going to talk about medications or drugs, expensive ones that aren't covered, or ones that perhaps are covered. And there's an opportunity to reduce the cost costs. You're paying for them. And we have a couple of our members here, Phillip and Daphne that have offered to provide some input on what this is, how it works and how you can hopefully possibly save some money. Right. So let's, let's start with like, like the basics. And either of you chime in on this, like what would be a typical situation that this pre-authorization process would apply to where you can, you know, likely reduce some medication costs who who'd like to tackle that one?

Speaker Phillip:

Well, I know one example is me being a kidney transplant patient. I have, an anti-rejection medicines that were not, they were covered, but they were extremely expensive. So I had to request a, um, um, what do you call it? Daphne? I can't think of the word with just the reduction in the price, price reduction and went from a tier three to two two, which reduced my costs about 30%.

Speaker Brian:

Okay. So for those that are listening out there, I'm just going to peel it back a little bit and thanks for that.  the drug pricing is structured in tiers, the higher, the tier, the more expensive it is. So one not so much to a little more, Phillip, you had a three, is that right? I hear that, right. Yeah. And so you moved a tier three price drug to where

Speaker Philip:

The tier two

Speaker Brian:

Tier two. Yeah. So what was,  in reduced your costs by 30%. All right. Great example.

Speaker Phillip:

Actual to two medications, two different medications, but yeah, they, um, it, yeah, it reduced it 30%.

Speaker Brian :

So if a tier, like a tier three medication is around, let's say $50. Right. Um, and you reduced it by 30%, that's $15 a month. Something like that. Yes. So $30 a month with the two of them, $400 a year, $400 savings. Right. Okay. Um, well that's good to know. So it wasn't hard to do. I

Speaker Phillip:

Mean, I just, there was no form I had to fill out, I just called United healthcare and requested the reduction in the, it was all done on the phone, just like that. Yeah.


And the saying is, is it a lot of people don't know that they don't know that they could call in and actually either get a reduction or get the medication covered, period. You know, they'll, they'll, send in a prescription or a doctor send a prescription it's not in the plan. They don't know that they can call in and get it, actually get it, put on the list and covered.

Speaker Brian:

This is interesting. I mean, it's, so it's as simple as calling you, just call, um, your, if you're on a Medicare advantage plan, you're going to call into United healthcare, Humana, Aetna, whoever has you planned WellCare, that's it? Yeah.

Speaker Daphne:

And do that, or you can have it, you can have your doctor take care of that for you. Yeah. Your primary care physician, she takes care of that for you.

Speaker Brian

So is there a starting point where this would be applicable to drugs? Like, is it, if somebody has a tier two, would they reduce that? Which might be only like $12 a month?

Speaker Dpahne:

Normally it's when the more expensive drugs and normally it's a tier four and you want to get it to a tier three source, more affordable or a tier three, and you want to get it to a tier two so that you can afford the drug prior authorizations or normally for, for me, I've experienced it for my clients,  hormonal drugs,  drugs that,  afford the hormones and the jobs are not covered initially. So what they have to do is get their primary care physician involved to get a, um, a prior authorization for their physician to get that covered. And normally it's covered for a year. And then after that year, before the year is over with, they have to put in another form to see if he provided recovery for another addition a year. Sometimes they can get it approved and sometimes the, um, the provider just would not cover it and, and they will have to go to a different type of drug.

Speaker Brian:

Okay. So I have up on the screen here, a form that, um, I found online and form will typically, the doctors will have it, is that right?

Speaker Daphne:

Yeah, they can do that because we have it or they can request it from the provider.

Speaker Brian:

Okay. So a few questions on the drugs that are covered, you guys are really providing some super information. Um, are there other common drugs this would be applicable for, like you mentioned, you know, Phillip's situation, definitely the one that you mentioned are there other, um, ones that might apply,

Speaker Daphne:

It may be a drugs that are new to the market that would apply. So let's say that,  there's a very new drug that's on the market and a lot of,  doctors are not using that. Right. But,  they may have to do a prior authorization to get that drug,  for the client to use it. So that's, that's,  another example, but I would say that for any drug that is not covered, the client finds out that it's not covered. They need to go through their primary care physician to have the physician take care of that for them.

Speaker Brian:

Okay. Just brings me to a few more questions there. Some drugs that Medicare does not cover that are not covered in any plans. How does that work into this? And I don't know of any off the top of my head. I'm not able to remember, but I have seen situations where people have brought this to me and I've looked them up. It says Medicare doesn't cover these drugs. So are you familiar with that situation?

Speaker Daphne:

They could go through the company that produces the drug.

Speaker Brian :

Oh, okay. So instead of this strategy, they could go direct to the drug company.

Speaker Daphne:

Yeah. The manufacturer all the times they have a program that the client can use. Exactly.

Speaker Phillip:

Yeah. There's two, two medication insulins that I use that I get through. Both of them come from the Lily. You can go directly to Lilly and yeah. Patient assistance program for your, to get for free, free.

Speaker Brian:

Wow. Wow.

Speaker Phillip:

But you have to, you have to meet income.

Speaker Brian:

That was my question. So there's there's criteria. Like if you meet this criteria, um, you know, income criteria.

Speaker Phillip:

Okay. It's a pretty, pretty low threshold. I mean, it's not some big hooks you'd have to jump through to qualify.

Speaker Brian:

All right. back to the, to the pre-authorization strategy, do you have any idea if companies have different criteria for pre-authorization? So for example, let's say you're with you're on an Aetna plan and you attempt to get a tier three drug reduced to a tier two, and you're not successful. Would that mean that you would have the same result if you went to another company? Does anybody have know about this

Speaker Daphne:

Know either, because normally when I was working with the call center, Aetna was the priority. Always try to get them through Aetna and Aetna. Um, the pre-authorization would always, work it's, you know, you could call it pre authorization or prior authorization. It would always work at least for that first year.

Speaker Brian:

Okay. Okay. Great. Great.

Speaker Daphne:

The biggest problem that a lot of people had was the obstacle that, that, the companies or the providers thought, giving it to them, like they used to get, you know, and they would, um, like say like only get like five for the week or something like that.

Speaker Brian:

Okay. Okay. Okay.

Speaker Daphne:

That was one where they were trying to get people, weed people off of that medication and try to get them or something else.

Speaker Brian:

So they wouldn't do authorizations for that part of their strategy. Like I understand their concept there. Good, good. Well, so is there anything else to add to this as far as like how this could help people out, anything you think I might've missed? And

Speaker Daphne:

I would say if you find that you have a medication that is not covered to get your doctor involved with it, as soon as possible so that you don't miss any of the dosages that you're supposed to have.

Speaker Brian:

Right. Right. So as a general rule, if you're paying, like, if you have a 30 day prescription that is over, like, what would you say, $30 a month, something like that, or would it be higher than that you think? Cause that would put it into tier three.

Speaker Daphne:

Yep. Yeah. We're talking about two different things. One is a prior authorization for your medication. The other one is more of a step therapy where you get the doctor involved with trying to get the medication at a different price level. One is a tier situation and the other one is getting the medicine authorized so that the provider will provide it for you for at least that year.

Speaker Brian:

Okay. And then the third would be, what Phillip had brought up. Come on next step. If somebody is listening to this replay, um, to contact your doctor, no, actually you should contact your Medicare,  provider and, um, see if they can help you reduce this. And if you don't know what your tier is, what, you know, if you're paying for, if you're paying like $30 or more for a medication, it's definitely something that, from what I'm learning from you two is worthy of pursuing. Right. Okay. Good, good. That's awesome. Thank you for your input for more tips from the disability digest. So look for links around this video, um, and, we'd be glad to help you out with other information that we have Daphne, Phillip, thank you so much.

The end 

Brian


My name is Brian Therrien, and I'm a professional researcher. So when a number of my friends went through unexpected downturns in their life and required disability assistance, I left no stone unturned to try and help them. At first, I was concerned with how to qualify for disability, ... but as I learned more about the system, I realized that people also really needed help with getting approved, maximizing their benefits, and most importantly, supplementing their income without losing their benefits when they were ready to transition back to the work force. That's why when you subscribe to my FREE disability newsletter you'll get concrete help with ALL the issues you'll encounter in the disability system

Brian Therrien

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