Here are some smart steps to take before asking your doctor to prescribe it for you.
Those captivating ads for new medications are everywhere, promising relief and often concluding with the familiar nudge: “Ask your doctor if [Drug Name] is right for you.” While these advertisements can introduce you to potential treatment options, do some research before you bring it up with your doctor.
A crucial step in this process, and one that can save you considerable time and frustration, is to contact your insurance provider before discussing an advertised medication with your doctor. There are no guarantees that a drug is covered under your insurance plan. Insurance companies maintain formularies – comprehensive lists of the medications they cover. These formularies are not uniform; they differ significantly not only between different insurance carriers but also among the various plans offered by a single company.
Even when a medication is listed as covered, the extent of your out-of-pocket expenses can fluctuate dramatically. Factors such as your annual deductible, copay amounts, and coinsurance percentages all play a role in determining the final cost you will bear. Contacting your insurance company directly provides you with a clear and accurate understanding of these potential costs.
If the medication turns out to be either not covered by your insurance or carries an unaffordable price tag, having this information beforehand opens the door to exploring alternative treatment options with your doctor. Often, there are equally effective medications within the same therapeutic class that are covered by your insurance plan, offering a more financially viable path to managing your health condition.
Therefore, when an “ask your doctor” advertisement captures your attention, here’s a practical roadmap to follow:
- Write down the name of the medication
- Reach out to your insurance company
- Ask about medication coverage under your specific insurance plan
- Ask if prior authorization is required from the insurance company
- Clarify your out-of-pocket costs
Once you complete this conversation with your insurance company, you will be significantly better equipped for a consultation with your doctor. You can discuss the advertised medication with a realistic understanding of its potential cost implications and insurance coverage status. This empowers you and your doctor to make a more informed and financially sound decision regarding your overall treatment plan.
At Dr. Gaber & Associates, our unwavering commitment is to provide you with the necessary information and resources to navigate the complexities of healthcare with confidence. By contacting your insurance provider before asking your doctor about an advertised medication you are guaranteeing a better outcome for you and your financial well-being.