Prescribers Choice = ADVRX Our Solution to Expensive Medications
As I wrote in the letter, I have been agonizing over the fact that we are in the dark about financial options for the medications we choose. We need to start having a discussion about your budget for medications, as well as trying to figure out what is best for each of you. There are various apps that might help us to determine what is least expensive (obviously while not getting inferior choices), and our electronic medical record helps but this is time consuming and not always accurate.
You don’t see what we do behind the scenes to get your medications covered by the insurance company. Called a prior authorization, there is a form to be filled out by us to show them what you have tried that hasn’t worked before. Another process, called a step-edit, is when your insurance company believes you should try 1 or 2 other prescriptions (ie cheaper) before they are willing to cover the more expensive one. We employ 1-2 employees full time just to take care of these prior authorizations described above. These employees then either fax or call the insurance company back (sometimes sitting on the phone, waiting up to 45 minutes to speak to a human being, who may or may not help!) If and when you call the insurance company, they tell you we haven’t processed your paperwork in a timely manner or at all (which is so galling to us…we can even prove the fax was received by them).
For many of the reasons above and more, we have partnered with Prescriber’s Choice, to offer you high quality generic medications available through the office. Many generic medications are now as expensive as brand name medications and your copays or co-insurance can be very high. This is a frustration for you and us because if you can’t afford your medications we can’t effectively treat your skincare issues. Although these medications aren’t covered by insurance, they are within range of what a typical copay might be now ($45–$65); in many cases, they are truly less expensive than the same medications if prescribed through your insurance. All have more than one ingredient in them to help the condition, sometimes 3 or more. These medicines are higher quality than generic medicines you get in the pharmacy because most generic medicines only must be within 15% of the dose or concentration of the brand name drug, whereas ours comes from an FDA-approved manufacturing facility where they must be within 3%.
We are going to start speaking with you about this right when you come in, so we can make sure that when you leave you know what to expect about the cost of your medication and if we aren’t sure then we will tell you that. Let’s be partners in sourcing the right solution for you and your family! We are trying to bring more solutions to the table for what has become a very difficult situation.