Paying for Medications and Understanding Your Health Insurance

Paying for Your Medication

How much your insurance company pays for your osteoporosis medication depends on the type of insurance plan you have. Osteoporosis medications require a prescription from your healthcare provider. They include oral medications that patients take by mouth, such as tablets and liquids. They also include injections that patients give themselves at home as well as nasal sprays and patches. View the different types of osteoporosis medications here.

You may pay a certain amount of money or co-pay for these medications. Most insurance companies have a formulary that lists the prescription medications that your insurance company has approved to pay either in part or in full. Once you understand how much your insurance will pay, you will then know what you need to pay for the medications you use to prevent or treat osteoporosis.

Understanding Your Health Insurance

Medicare Part D Prescription Drug Benefit

Medicare pays for prescription medications through the Medicare Prescription Drug benefit, also called “Part D”. This benefit is available to everyone with Medicare and may help lower the cost of your prescription drugs. If you want to have Part D drug benefits, you must sign up between three months before and three months after your 65th birthday, or between November 15th and December 31st of each year.

Review the 2012 Medicare Prescription Drug Annual Open Enrollment Q&A for answers to important questions that will help you during the Annual Open Enrollment Period.

Medications Given by a Healthcare Professional

Most insurance companies cover medications given by a healthcare professional in a medical office or hospital. The amount you pay for these types of medications is different from what you might pay for a medication you pick up at the pharmacy. If your doctor prescribes an osteoporosis medication that must be given in a healthcare provider’s office through an intravenous infusion or injection, you should find out how much your health plan pays for this type of medication, as well as how much it will cost you.

These medications may include ibandronate (Boniva®), denosumab (Prolia®), zoledronic acid (Reclast®) and sometimes Calcitonin (Miacalcin®).

FDA Warning: Buying Medication Online

The U.S. Food and Drug Administration (FDA) continues to warn people about the dangers of buying medicines over the Internet. Many people shop for their medicines over the Internet to save money. The FDA says it is risky and may actually cost more than cheaper generic versions that are available at pharmacies in the U.S.

Some people buy medicines over the Internet without a prescription. The FDA stresses that taking a prescription medicine without a prescription is unsafe. People taking prescription medicines need to be monitored by a healthcare provider. With some medicines, a person’s life can be at risk without proper monitoring.

Here are some safety concerns about buying medicines over the Internet:

• Medicines may be counterfeit (fake) or a different medicine than was ordered.

• Medicines may be made under conditions that are not clean or sterile.

• Medicines may contain harmful substances.

• Labels may not have information that is needed for the medicine to be used safely.

• Doses may be different from those used in the U.S.

• The FDA provides guidelines to help people decide whether a Web site selling medicines is safe. Web sites selling medicines should:

• Be located in the U.S.

• Be licensed by the state board of pharmacy where the Web site is operating. Visit www.nabp.info for a list of state boards of pharmacy.

• Have a licensed pharmacist available to personally answer questions.

• Require a prescription from your doctor or other healthcare provider who is licensed to prescribe medicines.

• Provide contact or customer service information.

The FDA recommends looking for the VIPPS^® Seal on Web sites selling medicines. Legitimate pharmacies that carry the VIPPS^® seal are listed at www.vipps.info. The National Association of Boards of Pharmacy (NABP) gives a seal of approval to Internet pharmacy sites that apply and meet state licensure requirements and other VIPPS^® requirements. VIPPS^® stands for Verified Internet Pharmacy Practice Sites.

The FDA has an article on The Possible Dangers of Buying Medicine Online. Read this article.

Part D Low-Income Subsidy (LIS)

If you have Medicare and limited income and resources, the Social Security Administration (SSA) (link to new www.socialsecurity.gov/) may help you pay the costs of your Medicare prescription drug plan. The SSA can also help you find organizations in your community that may help you to enroll in a Medicare prescription drug plan. Contact the SSA at 1-800-772-1213 or visit www.socialsecurity.gov.

Prescription Assistance

The Partnership for Prescription Assistance (PPA) brings together drug companies, doctors, other healthcare providers, patient advocacy organizations and community groups to help you get access to the medications you need if you are uninsured and qualify for help. On the PPA website you can find information on over 475 public and private patient assistance programs. PPA will direct you to public or private programs that can best meet your needs. You can also learn how to contact government programs you may qualify for, such as Medicaid or Medicare.

If you need assistance or would like additional information on the PPA, call 1-888-477-2669 or visit www.PPARx.com.

Another resource is www.NeedyMeds.com, which provides information on Medicare state programs and more. If you do not have a computer, you may want to visit your local library and ask a librarian to assist you.

And finally, the Patient Advocate Foundation provides assistance to certain insured patients who qualify. To find out if you are eligible, visit www.copays.org or call toll free to (866) 512-3861.

For more information, please download Patient Tools: What You Need to Know about Paying for Your Osteoporosis Medications.