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Managing chronic kidney disease (CKD) is challenging enough without the added burden of fluctuating medication costs. Medication prices often change throughout the year for patients in the United States due to factors like insurance plan adjustments, deductible resets, and price shifts.
This blog will outline how you can plan and manage the costs of CKD medications year-round, from the beginning of the year when insurance plans reset to mid-year savings opportunities. It also offers tips for how to be proactive in navigating your healthcare plan to keep costs under control.
A Year-Round Approach to Medication Cost Management
Medication costs for CKD can vary significantly throughout the year. Changes in your insurance plan, deductible resets, or even price adjustments from drug manufacturers can affect how much you pay. By understanding these factors and taking proactive steps, you can better manage your medication expenses, ensuring you’re not caught off guard by unexpected costs.
Why Do Medication Costs Fluctuate Throughout the Year?
Insurance plans typically adjust premiums and coverage details annually, often around January. Your deductible, which is the amount you must pay before your insurance begins to cover medication costs, resets at the start of the year. Additionally, pharmaceutical companies may raise drug prices or adjust their coverage policies. These factors can lead to higher out-of-pocket expenses at different times of the year, making it essential to plan ahead.
How You Can Be Proactive About Your Financial Planning for Medications All Year Long
Planning ahead for fluctuating medication costs is key. By understanding how the system works and using available tools, such as Health Savings Accounts (HSAs), discount programs, and reviewing insurance plans during open enrollment periods, you can effectively manage your budget for medications year-round.
Winter: Preparing for Deductible Resets and New Insurance Plans
From January to March, the first quarter of the year is when new insurance plans often roll out, and deductibles reset. It’s a good time to review your health insurance plan and ensure you’re prepared for any changes that may impact your medication costs.
Understanding Your Deductible Reset
Your deductible typically resets at the start of the year, meaning you'll be responsible for a larger share of your prescription costs until it’s met. You can use these funds to cover some costs if you have a Health Savings Account (HSA).
What is a deductible?
A deductible is the amount you must pay out-of-pocket for healthcare services, including prescriptions, before your insurance coverage kicks in.
How to check your deductible status and the expected costs for medications
Keep track of how much of your deductible you've already paid and check your pharmacy’s website for cost estimates. You can also contact your insurance provider to clarify your deductible status.
Planning for high-cost prescriptions early in the year
If you know you’ll have expensive prescriptions, it may be beneficial to plan ahead and refill these medications early in the year to reach your deductible faster.
Reviewing New Insurance Coverage for the Year
At the start of the year, reviewing your insurance plan’s coverage is important.
How to verify if your medications are still covered in your current plan
Check your plan’s formulary to ensure your medications are still covered. A formulary is a list of medications that the insurance will cover.
Steps to appeal coverage changes or how to switch plans if needed
If your medications are no longer covered, you may need to appeal the decision or switch plans during open enrollment.
What are formularies, co-pays, and out-of-pocket maximums?
A formulary is a list of covered drugs, while co-pays are the portion you pay for each medication. An out-of-pocket maximum is the limit on how much you'll pay for covered healthcare expenses in a year.
Planning Early Refills Before The Year Ends
If possible, refill expensive medications in December to avoid higher costs at the beginning of the year. Some patients opt to request a 90-day supply to cover them through the early months of the year.
Spring: Leveraging Medicare Enrollment and Coverage Adjustments
Spring (April to June) is an important time for those enrolled in Medicare, especially those who are dual eligible for both Medicare and Medicaid.
Medicare Enrollment Periods and Their Impact
Medicare has specific enrollment periods, including a Special Enrollment Period (SEP) for those with changing circumstances. If you qualify, it’s important to explore adjustments to your coverage that could affect your prescription costs.
Adjusting to Changes in Medicare Part D
Medicare Part D, which covers prescription medications, may change from year to year.
What do you do if your medication isn’t covered anymore?
If your medications are no longer covered under Medicare Part D, talk to your doctor about alternatives or contact your insurance provider to explore options.
How the donut hole affects out-of-pocket costs mid-year
The donut hole refers to a period when you need to pay a higher percentage of prescription costs after reaching a certain spending threshold. Understanding how it works can help you manage your costs better.
Summer: Taking Advantage of Mid-Year Savings Programs
During the summer months (July to September), several pharmaceutical discount programs become available, which can help reduce the cost of your CKD medications.
Using Pharmaceutical Discount Programs
Pharmaceutical companies often provide discount cards or coupons that can help reduce medication costs. Looking for discounted medication? We partnered with Cost Plus Mark Cuban Pharmacy to give our members the best deals on their prescriptions. Learn more here.
Preparing for the Second Half of the Year
Check your insurance usage to see if you’re close to meeting your out-of-pocket maximum. This could help you plan for the second half of the year, especially for high-cost medications.
Fall: Strategic Planning for End-of-Year Spending
As the year winds down, from October to December, it’s time to review your expenses and prepare for the upcoming year.
Using Your Insurance Benefits Before Year-End
If you've met your deductible, now is the time to schedule procedures or refill prescriptions before your deductible resets. Additionally, if you have a Flexible Spending Account (FSA), make sure to use those funds before they expire.
Timing Expensive Medications for Cost Savings
Try to schedule your high-cost prescriptions for November or December after you've met your deductible to maximize your savings. Comparing mail-order pharmacies to in-person pharmacy prices can also help you save money on refills.
Year-Round Tips for Managing Multiple Medication Costs
Managing medication costs year-round requires planning and awareness of your options.
Using 90-Day Fills and Mail Order Pharmacies
Opting for a 90-day supply, if available, can save money and reduce the frequency of refills. Additionally, mail-order pharmacies can often be cheaper than picking up prescriptions locally.
Reviewing and Adjusting Your Budget Regularly
Create a monthly medication budget to keep track of your costs. Contributing to an HSA or FSA can also help offset out-of-pocket expenses.
Coordinating with Your Doctor
Talk to your doctor about using generic medications instead of brand-name options. If your insurance denies a medication, you can always request a prior authorization to ensure the medication is covered.
Managing the cost of medications for chronic kidney disease (CKD) can be challenging, but with careful planning and a proactive approach, you can navigate the complexities of the U.S. healthcare system. By staying informed about insurance changes, leveraging savings programs, and coordinating with your healthcare team, you can minimize the financial burden of your medications year-round. With the right strategies in place, you'll be able to manage both your health and your medication costs effectively.