What do you do when you find a treatment you want to try but there is a waiting period before you can receive it? The reasons for the wait might include waiting for the insurance company to approve you, waiting for the patient assistance program to accept your application or a combination of both. I’ve been through the process and depending on how diligent your doctor is, it can be a frustrating process, so much so you might feel like giving up. I have received 3 different biologics which required me to go through an approval process. If you are in the same predicament I would like to share some tips with you about the process which may help your situation.
Ask the doctor if they have samples
Did you know doctor offices receive free samples of medicines including biologics? Although the samples are limited, a lot of doctor’s offices receive them from pharmaceutical reps. Ask your doctor if they have a sample of the medicine you need in the office. The hope is you can get started on your treatment while waiting for approval which shouldn’t take longer than a month. Understand this option is at your doctor’s discretion.
Pay administration fees if your doctor requires it
In the last two years, my doctor’s office has started charging an administration fee. This fee is for any paperwork or to make phone calls they may need to do on your behalf. You can elect to enroll in the program at the beginning of the year for a one time fee of $50, if you decide not to pay and later need the doctor to fill out paperwork or write a letter on your behalf the fee is increased to $125. I’m not sure if this is something all doctors offices do. Honesty initially I was a little appalled that my doctor would charge such a fee. But honestly, after encountering all the troubles of treatment approval with my insurance company and patient assistance program, the fee is worth it. My doctor’s office works really hard to ensure everything I need for treatment approval is taken care of. They speak to the insurance company on my behalf and any companies. It’s a real convenience and helps to keep my stress levels down so I don’t have to do it myself.
Apply for a patient assistance program
At times even if you have health insurance the medicine you might need could still cost too much, this is where the patient assistance program can help you. Several treatment options have assistance programs which will cover your co-pay or the remaining cost that your insurance may not cover. Also, your insurance company could completely deny your request for a particular treatment, it is good to have the patient assistance program as a backup plan, which may help you cover the cost. Upon insurance denial your doctor will have to write a letter to the insurance company explaining why you are in need of this medicine, it can be a process. Most patient assistance programs also calculate incomes as a factor so if you have a high income you could still be denied. The National Psoriasis Foundation shares additional tips on what to do if denied by insurance.
Request a temporary treatment
So let’s say your doctor doesn’t have a sample of the treatment you want to start and you are waiting for approval… Ask your doctor for some temporary relief like a strong topical steroid. Typically they are cheaper than most treatment options and they work fast. The downside is you are only supposed to use topical steroids sparingly and not for long period or it can thin your skin and cause stretch marks. This may be a good option for you to find relief until your other treatment is approved making for a “clear” transition.