Educational Videos

Demystifying the Medication Access Process

Pre-authorization. Co-pay assistance. Appealing denied claims. These are just a few of the issues facing people with vasculitis who suddenly have to navigate the complex process of acquiring specialty medications. In this webinar, Rachael Perritt, PharmD, BCPS, at University of Pennsylvania provides a clear roadmap for people living with the disease and their loved ones.  Rachael will cover topics including the pre-authorization process, appealing insurance denials, manufacturer co-pays, and the use of biosimilars.

Demystifying the Medication Access Process (Presentation)

Recorded December 2023

Introduction: Rachael Perritt 0:40
My doctor prescribed a new medication. Now what happens? 2:49
Formulary: A list of medications covered by your insurance. 4:08
Biosimilar Medications vs. Generic. 5:00
Biosimilar medications and interchangeability. 6:55
Understanding interchangeability. 9:08
Specialty medications. 10:07
Infusion medications. 10:49
Prior authorization. 11:45
Medication denied. Now what to do? 13:20
Co-pay programs. 15:29
Got the medication. Now what? 17:12
My information has changed. What do I do? 18:05

Demystifying the Medication Access Process (Q&A)

Q: Will your pharmacist automatically give you a generic version of a drug? What if you specifically want the brand version? 0:29
Q: Is there a difference as far as the insurance company is concerned with a med that needs prior authorization vs. one that is considered excluded? 1:33
Q: I’m confused about how the co-pay card works. Does it cover the cost of the medication except for the co-pay? 3:00
Q: How long does it take to go through the appeal process for a denied medication? 3:53
Q: Can you talk about Medicare and they don’t provide co-pay cards. Will that process change? 5:08
Q: If you have an issue with a generic medication and the allowed fillers seem to be a prob with one generic vs another. How can you go back to a specific manufacturer? 6:35
Q: How do you find out BEFORE selecting Medicare pharma plan which plans cover monoclonal antibodies such as Actemra for GCA? 7:54
Q: Is Rituxan only administered by infusion center only, or can it be done via home infusion? 8:46
Q: How hard is it to stay with the original biologic if a biosimilar is available? Having taken the original successfully and without side-effects, I don’t want to take the additional risk of another “similar” biologic infusion. 9:23
Q: My doctor is looking at a weight loss med because I am so stuck with the prednisone impact! With high BP and other issues I need to lose weight. My insurance is not covering basically any of them (since I don’t have diabetes). What options do I have since this is still a direct medical issue? 10:49
Q: Is Rachael aware of patient assistance programs where the drug manufacture may offer discounted cost on their medications? 12:42
Q: Some of the medications we’re taking are done by self-administering by a shot. What can we do that we get proper instruction in how to do this procedure? 13:51
Q: If you get coverage for a drug like Rituxan, but it turns out not to have been as effective as hoped, is it harder to get covered the next time? 16:31
Q: I was prior authorized for Tavneos by my pharmacy. but the co-pay was still expensive. The specialty pharmacy tried getting patient assistance. I was denied assistance as they said my diagnosis (EGPA) was not approved by the FDA. I was surprised that my pharmacy approved it, but the company refused it. 17:57
Can you talk about how the pharmacy benefit managers impact the system? The cost seems to change all the time. 19:51
Can an insurance company stop covering a drug like Actemra even if they had a one-year authorization approved? 22:07
I’ve been denied coverage for mycophenolate sodium for treatment of my MPA. I’ve gone through three appeals (physician letters provided) and Medicare/BCBS supplemental insurance denies coverage as the drug is not FDA approved for my condition. Any suggestions? 24:33