Thursday, September 15, 2016

Joint Decisions Blogger Spotlight: Access & Affordability Insights for RA Treatments

According to the Milliman Medical Index, in 2016 the cost of healthcare for an average American family of four covered by a typical employer-sponsored preferred provider organization (PPO) plan will be $25,826. The average family will also spend $4,270 on prescriptions this year. However, the key word when considering these statistics is this: average. In reality, some families will spend significantly less, and some families – like the ones where one or more family members live with a chronic condition – will spend significantly more.

I am the mom of an actual American family of four, and my diagnosis of rheumatoid arthritis has a tremendous impact on my family’s finances. Because, unfortunately, only patients who need to rely on specialty drugs have to figure out how to pay for them.

As someone living with a chronic illness, I know from personal experience that one of the most stress-inducing questions concerning my health is this: how on earth do I afford the treatment I need?

Understanding Your Coverage

Step one in attempting to answer this difficult question is to make sure you understand your health insurance coverage. Insurance plans can vary a lot, but important components to understand (if your plan has them) are the amounts of your co-pay, deductible, out-of-pocket maximum, co-insurance, and annual drug benefit limit. If you are taking a specialty medication, it may be covered by your medical benefits or pharmacy benefits, depending upon how it is administered. You can get more help understanding your coverage by watching the Joint Decisions Webchat: Benefit From Your Benefits: How to Make RA Treatment More Affordable.

If you still have questions about your coverage, or if a medication your doctor recommends gets denied, call your insurance provider and ask them about it. Part of their job is to help you understand your coverage, so don’t hesitate to ask the same question multiple times if you need a better explanation. I also find it useful to take notes during a call, including the name of the person I am speaking to. That way I will have something to reference if I need to call back about the same issue.

Record Your Medical Spending

Keeping a careful record of your medical spending can be useful for several reasons. A record can help you figure out when your deductible has been met or spot errors in your bills – which do occur! I keep a Google spreadsheet to keep track of my family’s medical spending, and while it can be a bit overwhelming to see our healthcare spending add up, knowing our expenses does help us create a more accurate budget for our family.

A detailed record is also potentially useful for tax purposes, as the IRS allows you to deduct qualified medical expenses that exceed 10% of your adjusted gross income for the year – and given the statistics above it is easy to see how that can happen! Qualified medical expenses include premiums, preventative care, treatment, lab fees, surgeries, doctor’s visits, and prescription medications. You can also deduct a few things you may not have considered: acupuncture fees; mattresses bought specifically to alleviate an arthritic condition; the cost of installing special equipment like grab bars in your bathroom; and medical aids such as wheelchairs, canes, or braces. Any travel expenses you incur attending medical appointments should also be included, such as mileage on your car, parking fees, bus fares, or lodging expenses if you have to stay overnight.

But keep in mind that any expense you are reimbursed for – such as by your insurance or your employer – does not count. Things like over-the-counter medications, vitamins, or health club dues are also not deductible. The IRS maintains a complete list of deductible health expenses, which you can look at here.

Support Programs

If you are still struggling to pay for all your medical expenses, the good news is that there are many types of programs available to help ease the burden. A co-pay assistance program or pharmaceutical assistance program may help you cover the cost of an expensive specialty medication. There are also patient assistance foundations available to help. These programs can help patients access and pay for expensive medications, provide direct financial support or travel assistance, or locate appropriate assistance and support programs. CreakyJoints maintains an index of available arthritis copay cards and assistance, for easy reference.

With the help of these tips and resources, hopefully it will be easier for patients living with RA to access and afford the treatments they deserve.

This post is sponsored by Joint Decisions, an educational initiative developed by Janssen Biotech, Inc. that empowers people living with RA to take a more active role in the management of their disease and have more open and honest conversations with their doctors. Janssen Biotech has compensated me for this article. All thoughts and opinions expressed here are my own.

Check out the Joint Decisions Facebook page to connect with others in the online RA community, and visit for RA resources and tools.

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