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Second-Guessing Your Doctor: Possible Barriers to Access

Allyson Funk   |     October 29, 2014   |   SHARE THIS

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When selecting health insurance coverage to suit you and your family’s needs, you may think it is safe to assume your plan will help cover the medicines prescribed by your doctor. This, however, is not always the case. Beyond making sure the treatment you need is listed on an insurance company’s list of covered medicines or formulary, there may be additional steps insurers require before you can get the medicine you were prescribed.

OInsurers-Limit-Use-of-Medicinesur latest video walks through terms like step therapy or fail first and prior authorization. These are processes your insurer may require you to complete before covering the medicine your doctor prescribes. In instances where you and your doctor have already determined that a different medicine doesn’t work, this can be an added burden. And as our last video explained, even after your insurer agrees to cover a medicine, you may be responsible for additional out-of-pocket costs.

This is another example of challenges you may face when trying to access the medicines you need. Don’t forget to check back in with the new Access Better Coverage (ABC) website and Twitter handle for more videos and information to help you better understand your health care coverage. 

Allyson Funk

Allyson Funk Ally is a former senior director of public affairs at PhRMA focused on advocacy issues for the biopharmaceutical industry. Her expertise includes Medicare, Medicaid, 340B, health reform and more. Prior to PhRMA, her experience included leading health communications for a large membership organization, supporting public affairs clients and working for the governor of Louisiana.

Topics: Health Insurance, Access Better Coverage

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