PHA Pathlight Spring 2014 - (Page 15)

Helpful Hints n avigating the Affordable Care Act (ACA) and understanding how it applies to your pulmonary hypertension medications and insurance is critical. What follows are some tips to help you be proactive about changes in your insurance drug plans and to know where and who to call with questions. I. Know Your rIghts under the ACA How will the ACA affect me or my PH caregiver? The ACA does not fully address all of the concerns of the PH community. However, many of the ACA's provisions align with PHA's long-standing advocacy initiatives to improve the quality of care for PH patients. The ACA includes provisions that: * Eliminate lifetime limits on essential medical expenses; * Prohibit insurers from dropping your coverage or raising your premiums if you get sick - or from denying coverage if you have a pre-existing condition; * Ensure that your child can stay on your health plan until age 26; * Cap annual out-of-pocket medical and drug expenses at an estimated $6,400 for individuals and $12,800 for families; * Establish high-risk pools for people with pre- existing conditions who have been uninsured for at least six months; * Eliminate pre-existing condition exclusions for people 19 years of age and younger; * Require insurance coverage of routine patient care costs associated with clinical trials; * Gradually phase-out the Medicare Part D (prescription drug) "donut hole" (began in 2010 and completely phases out in 2020). For plan years beginning on or after Sept. 23, 2010, the ACA prohibits most plans from imposing pre-existing conditions limits on covered persons under age 19. For plan years beginning on or after Jan. 1, 2014, the ACA prohibits most plans from imposing pre-existing condition limits on covered persons of any age. It is important to fill out all forms completely and without mistakes. Misrepresentations of material facts can call your insurance coverage into question. II. use Your speCIAltY phArmACY As A resourCe Where to turn if you are experiencing a temporary disruption in your insurance coverage: Contact your specialty pharmacy to ask about bridging services. Specialty pharmacies have programs set up to help patients who are experiencing a temporary disruption in insurance coverage with a transitional or "bridge" supply of medication to support their continuity of care. A bridge supply is a prescription of 15 or 30 days. Call your care team as soon as you know of any changes to your insurance. They will check your new benefits to find how much of your drug will be covered. Many insurance companies need to give their permission ahead of time, and this can take as long as 30 days. Be sure to let your care team know as soon as possible to avoid a delay in getting your medication. HEALTH MATTERS Ov ercom in g B ar rier s to G e t t i n g Yo u r P H M e d i ca t i o n s III. use Your emploYer or Former emploYer As A resourCe Your Human Resources (HR) Department will know the details of your benefit plans. Before you change plans, give your specialty pharmacy a call if you have any questions. Ask whether your plan maintains a separate list of specialty medications that are covered. Keep in mind that the formularies are constantly in flux. If you lose your job, you can sometimes keep your policy with your employer for 18 months. You will have to pay the insurance company to keep the coverage. This benefit is provided through the Consolidated Omnibus Budget Reconciliation Act (COBRA). You must get this benefit within 60 days after you stop working. Another option is to ask for coverage under a state program or short-term medical insurance policy. Check with your HR Department for additional details on these programs. Go to to learn more about the ACA, insurance and patient assistance programs. For contact numbers for your specific medications, see the "Insurance Resources" section on the inside back cover of this issue of Pathlight. You can provide feedback to your specialty pharmacy by using PHA's Specialty Pharmacy Feedback Form at specialtypharmacyresponseForm. w By Jennifer H. Keeley, ANP-BC, DNP, University of Pittsburgh Medical Center Comprehensive Pulmonary Hypertension Clinic, Pittsburgh, Pa. PATHLIGHT SPRING 2014 Patient-to-Patient Support Line: 1-800-748-7274 15

Table of Contents for the Digital Edition of PHA Pathlight Spring 2014

PHenomenal Lives
Coping with PH
Health Matters
Ask a PH Specialist
Helpful Hints
Research Corner
Advancing the Cause
Support Groups
Special Events
Chapter Happenings
Persistent Voices
Community Classroom
Conference Preview
PHenomenal Youth
Family PHocus

PHA Pathlight Spring 2014