Navigating through your health plan benefits can be confusing. Adding to the confusion is that you may be noticing benefit differences from the year before.
Increasingly, one of those differences is the prescription medicines to which you have access.
For years, insurance plans have attempted to reduce their expenses by limiting access to certain prescription drugs for their members. But new research shows that steering patients to particular medicines to save on costs may be bad news for consumers, especially minority patients.
America has enjoyed tremendous innovations in pharmaceuticals over the course of the past century. These innovations are well recognized for their contributions to the quality and duration of life among our citizens. Unfortunately, all of our communities have not benefited to the same degree, said L. Natalie Carroll, M.D., president of the National Medical Association (NMA), an organization representing African-American physicians.
The study, jointly sponsored by NMA and the National Pharmaceutical Council, was published in the peer-reviewed Journal of the National Medical Association. It shows that genetic differences among minorities may explain why some medicines are more effective in some patients than others.
Genetic variations can affect how fast a drug is metabolized and what kind of dosage is appropriate. For example, Black patients and Caucasian patients often experience different types of high blood pressure. Because black patients tend to retain more salt and have a higher incidence of salt-sensitive high blood pressure, diuretics used in combination with other blood pressure medications may be necessary to maintain healthy blood pressure levels among Black patients.
What this means to health plan members is that the drug your insurance plan prefers may not be your best bet. Here are some tips to help you ensure that the medicines you take are the best ones for you:
Talk to your doctor -- Work with your doctor to find the best treatment option for you. Discuss the pros and cons of different therapies. If your insurance plan is steering you to switch medicines, discuss the possible effects on your current condition and create a plan of action.
Know your options -- Research what your plan covers. Dont be afraid to contact your plan administrator if a drug you need isnt covered or has an expensive co-pay. Many plans allow patients to apply for medical exceptions to their coverage policies based on the advice of a doctor. Know your plans rules and be persistent.
Be mindful of chronic conditions -- Be careful of switching medications especially for conditions that require careful ongoing maintenance, like high blood pressure, diabetes, and mental illness. Even if they are used to treat the same condition, no two drugs will work identically. If you do need to change the drug you use, it may take some time for your doctor to determine the correct dose.
Be alert for unanticipated responses -- Because each patient is different, every drug will have its own unique impact on a patients health. If you experience an increase in side effects, or a change in your condition, alert your physician immediately.
As health plans increasingly limit access to certain medicines, it is important for patients to work hand in hand with their physicians and their health plan to make certain that they are treated for their individual condition. The ultimate goal must be to get the right drug, to the right person, for the right condition at the right time.
For more information on the study please visit http://www.npcnow.org/issues_productlist/IndRxCareintro.asp.
Founded in l895, the National Medical Association (NMA) is the nations oldest and largest medical association representing the interests of more than 25,000 African-American physicians and their patients.
The NMA is a strong advocate for policies that would assure equitable health care for all people. Since 1953, the National Pharmaceutical Council (NPC) has sponsored and conducted scientific, evidence-based analyses of the appropriate use of pharmaceuticals and the clinical and economic value of pharmaceutical innovations.
NPC provides educational resources to a variety of health care stakeholders, including patients, clinicians, payers and policy makers. More than 20 research-based pharmaceutical companies are members of the NPC.
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