Momwe mungalipire ndalama zomwe mumalandira popanda inshuwaransi

Kampani

Kaya mwataya ntchito (ndi maubwino omwe munapeza nayo), kapena muli ndi mapulani ochepetsa mankhwala omwe simukufuna, mwina nthawi zina mumayenera kudzaza mankhwalawo popanda inshuwaransi. Ngakhale mitengo yamankhwala yokha itha kukhala yokwera, mtengo wamankhwala wopanda inshuwaransi ukhoza kukhala wotsika mtengo pafupifupi 25% za nthawiyo. Zowonjezera ndi ziti? Pali njira zambiri zopezera ndalama zochulukirapo ku pharmacy.

ZOKHUDZA: Palibe inshuwaransi yazaumoyo? Yesani izi zothandizira 2020

Mukufuna inshuwaransi kuti mupeze mankhwala?

Kuyenda njira yazaumoyo popanda inshuwaransi yaumoyo kungakhale kovuta, koma sikuyenera kukulepheretsani kupeza chithandizo chamankhwala. Mutha kukaonana ndi dokotala ndi kukalandira mankhwala popanda inshuwalansi -Koma muyenera kusankha wothandizira zaumoyo mwanzeru kuti muchepetse mtengo. Makliniki azachipatala ndi njira yabwino kwaulere kapena ntchito zotsika mtengo, ndipo ambiri amapereka mitengo yotsika potengera zomwe mumapeza. Makliniki oyenda komanso malo operekera mwachangu amalola odwala kulipira ndi ndalama, koma mitengo yawo imasiyana mosiyanasiyana. Mbali inayi, mankhwala —Kulankhulana ndi dokotala patelefoni kapena kudzera pawebusayiti — nthawi zambiri kumakhala kotsika mtengo kuposa kupita kuofesi. Kafukufuku wa 2017 wofalitsidwa mu Zaumoyo adapeza kuti odwala omwe amapuma amawononga ndalama zokwana $ 79 paulendo wapa telefoni poyerekeza ndi $ 146 popita kuofesi (ngakhale zidapezanso kuti mwayi wapa telehealth ungawonjezere ndalama).

Mtengo wa kuchezera ofesi ndi inshuwaransi motsutsana ndi kunja ndi kovuta kuwunika, chifukwa zinthu zambiri - kuphatikiza malo ndi nthawi yochezera - zonse zimathandizira. Mwachitsanzo, kuchezera kwa ofesi kwa mphindi 15 ku Seattle, kumakhala pakati pa $ 128 ndi $ 398 pomwe ulendo womwewo wodwala ku New York umadula $ 138 mpaka $ 430, malinga ndi Zaumoyo Blue Book . Pakadali pano, ma copays oyendera dokotala wamba amakhala pakati pa $ 15 ndi $ 25, malinga ndi ngongole.org .

Kusiyanasiyana komweku kumafunanso mankhwala akuchipatala. Mankhwala osokoneza bongo Lyrica Mwachitsanzo, amakhala pamtengo kuchokera $ 460 mpaka $ 720 pamwezi popanda inshuwaransi. Zolemba pamankhwala zimasiyanasiyana kutengera omwe amapereka, koma ma kopi angapo amachokera $ 11 mpaka $ 105 kutengera gawo la mankhwala, malinga ndi kafukufuku wa 2018 kuchokera ku Kaiser Family Foundation .

Kodi mankhwala akuchipatala amawononga ndalama zingati popanda inshuwaransi?

Palibe amene angakane kuti mitengo yamankhwala omwe akupatsidwa ndi mankhwala ikupitilizabe kukwera. Chaka chino chokha, mtengo wogulitsa wa mankhwala 460 wawonjezeka ndi avareji ya 5.2%, malinga ndi kafukufuku wa zaumoyo 3 Axis Advisors. Pafupifupi, aku America amawononga pafupifupi $ 1,200 chaka chilichonse kugula mankhwala, malinga ndi kafukufuku wochokera ku Organisation for Economic Co-Operation and Development . Kwa ambiri osalimbikitsidwa, kukwera mtengo kumatanthauza kuti ayenera kusankha pakati pa kumwa mankhwala omwe amafunikira ndikulipira zofunika monga renti ndi chakudya. M'malo mwake, a Kafukufuku wa 2016 adapeza kuti 14% ya aku America osatsimikizika mwina adalumpha Mlingo kapena sanadzaze mankhwala chifukwa cha mtengo wake. Mwachidule: Mitengo ya mankhwala ikudyetsa anthu aku America ndalama zoposa madola okha-nawonso akuwonongetsa thanzi lathu.

Pali zinthu zambiri zomwe zimaseweredwa zikafika pamagulu amomwe mankhwala amachokera. Pamlingo wokulirapo, opanga amati kukwera mtengo kwa mankhwala amodzi nthawi zambiri kumathandizira kuthana ndi kafukufuku ndi chitukuko cha mankhwala ena. (Komabe, alipo ambiri Zowonongera mankhwala zomwe sizinalembedwe potanthauzira izi .)

Pang'ono ndi pang'ono, ndipo ngati muli ndi inshuwaransi, ndalamazo zimatsimikiziridwa ndi mapulani a mapulaniwo (omwe amadziwikanso kuti mndandanda wazamankhwala), womwe umafotokoza dzina la mankhwala ndi mankhwala omwe amapangidwa ndi inshuwaransi yanu. Kuchokera pamenepo, formulary nthawi zambiri imagawika m'magawo atatu (kutengera zinthu monga mtengo, kupezeka, ndi zina zambiri), ndi mtengo wakuthumba womwe wapatsidwa gawo lililonse. Chifukwa chake kulipira limodzi kwamankhwala amtundu wa 4, mwachitsanzo, kumatha kusiyanasiyana mosiyana ndi kulipira limodzi kwa mankhwala amodzi.

Zomwe zimakhudzanso copay yanu ndi wosewera pamakampani ochepa aku America omwe mwina adamvapo-amatchedwa Pharmacy Benefits Manager (PBM). Makamaka pakati, PBM imagwira ntchito ndi ma pharmacies, makampani a inshuwaransi, ndi opanga mankhwala kuti athetse magulitsidwe. (Kwenikweni, PBM imathandizira kampani ya inshuwaransi kusankha mankhwala omwe adzagwiritse ntchito (mwachitsanzo, formulary yake) ndi momwe azilipira omwe amawapangira.)

Chifukwa chiyani mankhwala ena ndiotsika mtengo popanda inshuwaransi?

Mitengo yamankhwala opanda inshuwaransi itha kukhala yotsika mtengo 25% yanthawiyo. Koma zingatheke bwanji? M'dziko langwiro, PBM ingafune kupeza mtengo wotsika kwambiri ku kampani ya inshuwaransi, koma nthawi zambiri, wopanga mankhwala osokoneza bongo amaponyera ndalama kuti PBM isankhe dzina lake m'malo mwa generic. Zodabwitsazi, zomwe zimatchedwa zolemetsa zamagulu azachipatala, makamaka ndi komwe kukopera kwanu kumathera. Umu ndi momwe zimagwirira ntchito:

• Mukupatsidwa mankhwala omwe anali $ 30 okha chaka chatha, koma kuchuluka kwanu kopayola tsopano akuti ndi $ 75.
• Pharmacy imalandira ndalama zanu zokwana $ 75 ndipo mutha kuganiza kuti akupeza phindu labwino chifukwa zimawawononga $ 15 kugula mankhwalawa.
• Zomwe simukudziwa ndikuti $ 50 ya $ 75 yanu imabwerera ku PBM ngati clawback.

M'malo molipira ndalama zokwana madola 30 ndikulola kuti kampaniyo ipatse $ 15 mutalipira mankhwalawa, kubweretsa ma PBM kusakanikirana kumapangitsa mitengo yamankhwala kukwera mwachangu kuti nawonso atenge gawo lawo. Gawo loipitsitsa kwambiri? Asayansi samaloledwa kukuwuzani zamtunduwu , potero zitha kusokoneza ubale wawo ndi omwe ali ndi ma inshuwaransi ndi ma PBM.

Kodi SingleCare imagwira ntchito popanda inshuwaransi?

Kaya muli ndi inshuwaransi ndipo mukukumana ndi copay yayikulu kapena mulibe inshuwaransi ndipo mukuwopa mtengo wotuluka mthumba, khadi ya SingleCare ikhoza kukhala yankho pochepetsa chiwonkhetso cha risiti yanu.

SingleCare si mtundu wa inshuwaransi, koma khadi yotsatsira yomwe ndi yaulere kwa makasitomala onse ogulitsa mankhwala ku United States, kuphatikiza omwe alibe inshuwaransi. SingleCare imagwira ntchito popanda inshuwaransi, chifukwa kuchotsera kumagwiritsidwa ntchito pamtengo wamtengo wapatali. (Werengani: Simungathe kugwiritsa ntchito khadi yanu ya SingleCare ndipo inshuwaransi yanu pamankhwala amodzi.)

Ndiye ndindalama zingati zomwe mungasunge pamtengo wamankhwala ndi SingleCare? Pang'ono pang'ono, kwenikweni . Mwachitsanzo, mu 2019, mtengo wapakati wa mankhwala a ADHD amphetamine-dextroamphetamine inali $ 131.67. Mtengo wapakati wa SingleCare? $ 47.57 yokha. Ogwiritsa ntchito makhadi a SingleCare adawona ndalama zofananira pamankhwala ochepetsa mafuta m'thupi atorvastatin calcium. Popanda khadi mtengo wapakati unali $ 105.68. Ndi khadi: $ 29.06.

Kuphatikiza pa khadi la SingleCare, pali njira zingapo zochepetsera mtengo wamankhwala anu:

• Funsani dokotala wanu za generic: Mankhwala omwe amatchulidwa mayina nthawi zambiri amakhala okwera mtengo kuposa mankhwala achibadwa. Kubwereranso ku chitsanzo cha Lyrica, pomwe mankhwalawa amatenga $ 460 mpaka $ 720 pamwezi, mtundu wa generic umakhala pakati pa $ 140 ndi $ 370 pamwezi.
• Funsani dokotala wanu mankhwala ena: Kodi mtengo wamtengo wa mankhwala ena a kuthamanga kwa magazi ndiotsika kwambiri kuposa womwe mukukhala nawo pano? Funsani dokotala ngati mungathe kusintha.

Fufuzani mapulogalamu othandizira odwala: Ambiri opanga mankhwala osokoneza bongo komanso mabungwe osapindulitsa amapereka mapulogalamu ochotsera anthu omwe sangakwanitse kugula mankhwala, omwe angatanthauze mtengo wotsika kapena ngakhale mankhwala aulere. Zofunikira pakuyenerera zimasiyanasiyana, chifukwa chake muyenera kufunsa kampani yopanga mankhwala kuti muwone ngati mukuyenera.