In this post, we will discuss some tips on how to choose a health insurance plan based on a recent webinar presented by Pfizer and hosted by the Turner Syndrome Foundation (TSF). Particularly, we will focus on considerations to think about when managing a rare disease like Turner Syndrome (TS) and how that can affect your choice of health plan.
Note: The information in this post is educational and is not meant to replace medical advice from your physician(s). Always consult with a medical professional regarding any health concerns.
Choosing a health plan can be a daunting task. However, if you ask the right questions and take the right educational and planning steps, you can find the most effective plan for you. We will attempt to demystify the process of choosing a health plan by suggesting considerations to think about when looking at health plans and a few resources for choosing one. This information is based on a recent webinar presented by Pfizer and hosted by the Turner Syndrome Foundation (TSF).
How To Choose a Health Plan
- Educate yourself on insurance terminology: Knowing the different terms can help inform and guide which benefits you can expect to receiving with different plans.
- Understand insurance changes at key life stages: Different life stages have different implications for your health insurance plan, so it’s important to take into consideration what types of treatments or healthcare considerations you will need at certain stages of your life–especially as it relates to chronic conditions like TS.
- Evaluate your insurance plan’s cost, benefits, and choices: Thinking about the value of your plan and doing some upfront work to compare copayments and costs with different plans for treatments, tests, and medications you know you will need can help determine which plan makes the most sense for you.
Questions To Ask
Asking specific questions will help guide your decision-making process in choosing a health insurance plan. Click here for a handout of suggested questions to ask. Think about how the various questions you should ask yourself relate to the chronic conditions you’re experiencing. Here is a non-exhaustive list of things to think about, specifically when asking these questions:
- growth hormone therapy (GHT),
- coverage for endocrinologists and other specialists,
- special medical equipment, and
- physical, occupational, or mental healthy therapy.
Hubs and Specialty Pharmacies
Hubs through drug manufacturers (e.g., Pfizer) and specialty pharmacies work very closely together to help aid in the continuum of patient care. These entities partner with your health plan to ensure the delivery of medications and services. Therefore, it’s advisable to ask about the level of support that hubs and specialty pharmacies working with your health insurance plan offer.
- Hubs offer programs and options for patients that may include help with benefits investigation and verification, prior authorizations, drug delivery/administration, copayment support, financial assistance, and patient education.
- Specialty pharmacies distribute specialty products and medications to treat complex, chronic, or rare conditions (e.g., growth hormone therapies) and typically provide more support and offerings than retail pharmacies.
Pfizer Bridge Program for Genotropin
The Pfizer Bridge Program is a Pfizer-sponsored program to help patients navigate their healthcare. It is just one example of a pharmaceutical company’s assistance program, and most companies that offer growth hormone have similar options available. See a list of more programs here.
With Pfizer Bridge, you are paired with a patient care consultant (PCC) who will work with your physician, health insurance plan, and pharmacy to help you get started on Genotropin, Pfizer’s growth hormone replacement therapy. The program specifically helps with:
- assisting you in the insurance process;
- arranging the first Genotropin shipment from the pharmacy;
- addressing issues that may lead to pharmacy delays or treatment interruptions;
- providing a Genotropin welcome folder including educational materials to help you get started on treatment;
- providing on-going support through a support hotline; and
- supporting patients through the Genotropin Navigator program, which offers tips and resources for therapy, activities and ideas to keep your child engaged, and updates/reminders during important times of the year.
Additional Online Resources
- Finding Healthcare Insurance
- Medicaid Website
- CHIP Website
- Healthcare Exchange
- Centers for Medicare and Medicaid Services (CMS)
- Patient Affairs Liaison – Pfizer Bridge Program
Written by Reyn Kenyon, TSF volunteer blog post writer and editor, and edited by Susan Herman, TSF volunteer blog post editor and translator.
To learn more about choosing the right health insurance plan, watch the Insurance & Reimbursement webinar and download the handout at this link:
For more information regarding TS treatment, click here.