Benefits Verification Checklist for Arthritis Medications
Having access to your prescription medications is key to treating arthritis. This checklist will help you get started.
- Check Your Formulary: Review the list of approved medications in your benefits booklet or on your insurer’s website. If your medications aren’t included, talk to your doctor right away. It may be necessary to work together to file an appeal so you can get access to the drug.
- Check Your Requirements: Review your health plan’s summary of benefits carefully. It will outline the policies that affect the drugs you use e.g. step therapy or prior authorization requirements. Then you should follow up with your doctor’s office as soon as possible to start the paperwork or online submission process.
- Check Your Out-of-pocket Cost Obligation: Your summary of benefits will outline how much you need to pay for your medications. It will confirm if you need to pay a co-pay or co-insurance amount, and whether you must satisfy a deductible before your insurer begins to pay their portion of the cost. It’s important to know that some plans have a health plan deductible for medical care and a separate medication deductible. If this information is not available on your summary of benefits or you have questions, contact your insurer.
- Check Your Pharmacy Requirement: Your health plan may require you to use a specific pharmacy or receive your medications by mail. This information should be included in your summary of benefits.
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