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Medicati ons prescribed to you by your doctor can help treat acute and chronic illnesses, prevent and shorten hospitalizati on stay, and improve your overall quality of life. These benefi ts are someti mes not realized due to the high cost of your medicati ons. Insurance plays a large role in keeping prescripti on costs down but unfortunately some aspects of insurance coverage are oft en misunderstood by pati ents. Let us help you through the confusion by answering some commonly asked questi ons about how your insurance works!

Why are some of my medicati ons not covered by my insurance? Medicati ons may not be covered if they are non-formulary prescripti on drugs. Insurance companies develop a formulary (or list) of medicati ons approved to be prescribed in order to help reduce costs while off ering medicati ons that have proven to be both safe and effi cacious for pati ents.

What is a deducti ble?A deducti ble is a fi xed amount that an insurance holder must pay out-of-pocket before your insurance starts to cover the remaining medical services. The fi xed amount varies with each plan and may not apply to some medical services which will be detailed by your insurance.

What is a prior authorizati on?In certain instances your medicati on is not covered by insurance unti l a prior authorizati on is completed. A prior authorizati on is when your prescriber contacts your insurance for approval to prescribe this medicati on. This process can take up to three days. Medicati ons that require a prior authorizati on may be a brand name medicati on (instead of a cost-saving generic), a more expensive medicati on, a non-formulary drug, or medicati ons that are prescribed to treat non-life threatening medical conditi ons. If a prior authorizati on is not obtained, then the insurance will not cover the medicati on and you have to pay out-of-pocket for the prescripti on.

What is the diff erence between brand and generic drugs?Brand name drugs are trade name medicati ons that are protected by a patent and can only be sold by a specifi c company. Generic drugs have the same acti ve ingredient, strength dosage form and route of administrati on as brand name medicati ons. These generic medicati ons may look diff erent or have inacti ve ingredients and they generally cost less than brand name medicati on.

What does it mean when my medicati on is “refi lled too soon”?Your medicati on can be refi lled 5-7 days before the full quanti ty provided is used. Refi lling before this ti me will alert the

pharmacist that it is too soon and your medicati on will not be fi lled. This is to prevent sharing of medicati on between a pati ent who does have insurance and a pati ent who does not have insurance. It can also help your pharmacist or prescriber determine if you are compliant with the medicati on or if the medicati on is working for you. This will help to increase all the benefi ts listed above to improve your quality of life.

What is a quanti ty limit?A quanti ty limit is placed on a medicati on for various reasons. Some insurance plans will limit the amount of the medicati ons they cover to either a thirty day supply or a ninety day supply. There are also instances where a medicati on is indicated for every day dosing but your prescriber believes you require twice daily dosing, exceeding the quanti ty limit. In this case, you would need a prior authorizati on before the script could be fi lled.

I am going on vacati on! Can I receive my prescripti ons in advance?Proper planning can guarantee that you will be able to receive your medicati ons before vacati on. Some insurance plans allow additi onal quanti ti es to be fi lled before the expected refi ll date. In order to do this, you must contact your insurance preferably two or more weeks prior to departure for your vacati on in order to receive an approval for a vacati on supply of drugs. Once this is completed, your medicati ons can be fi lled.

What is Medicare Part D?Medicare Part D (also known as Medicare prescripti on drug benefi t) is an opti onal plan which helps to subsidize the cost of prescripti on drugs. To be qualifi ed for this coverage you must have Medicare part A or B. Medicare plans are indicated for people 65 years and older, people below 65 with certain disabiliti es and those who have End Stage Renal Disease (for more informati on: htt p://www.medicare.com/part-d-plans/who-qualifi es-for-medicare-part-d-coverage.html).

What is a coverage gap?A coverage gap or a “donut hole,” is when those who are enrolled in a Medicare Prescripti on Drug plan have a temporary limit on what the plan covers. The amount you and your insurance pay in order to reach this gap may vary each year. For 2014, you and your plan must spend $2,850 in total towards covered medicati ons. Once entering the coverage gap, you will pay 47.5% of the plan’s cost for brand name drugs and 72% of the price for generic drugs. For brand name drugs the enti re price you and the company pays will count towards the coverage gap; whereas, for generic drugs only the amount you pay will count towards the coverage gap. Once $4,550 is spent, the coverage gap will close and the costs of

your medical services will be covered. The Aff ordable Care Act is working to close this gap but decreasing the percentage you pay each year unti l it reached 25% in 2020. (for more informati on: htt p://www.cms.gov/Outreach-and-Educati on/Outreach/Partnerships/downloads/11522-P.pdf)

Why is there higher copayment on some of my medicati ons but not others?Aft er the deducti ble is paid, a copayment is required for medical services. Copays are out-of-pocket expenses paid hen you receive a medical service in additi on to what your insurance is paying for the service. The amount you pay will vary depending on your insurance as well as what medical service you seek. Copays for medicati on depend on their drug category or ti er. Tier 1 medicati ons are usually generic medicati ons which have the lowest copay. Tier 2 medicati ons are known as preferred brand name medicati ons whereas ti er 3 are non-preferred brand name medicati ons. The diff erence between a preferred and a non-preferred medicati on is dependent on the price that the insurance negoti ates with the manufacture of the drug. Tier 4 has the highest copay and is reserved for medicati ons that are considered “specialty” drugs. Specialty drugs are prescribed for a rare conditi on or require special administrati on or monitoring.

Why is my Zostavax vaccine not covered by my insurance?According to the CDC, the Zostavx, or shingles vaccine, is recommended for adults ages 60 and older in order to protect from reacti vati on for the varicella-zoster (or chickenpox) virus. The Zostavax, or shingles vaccine, is not covered by Medicare Part A or B but it is covered by Part D plans. Rules for coverage should be checked with your insurance.

Why is my compound not covered under insurance?As you know, Four Corners Pharmacy does compounding for both you and your pets. However, someti mes these compounds are not covered by insurance because they are not commercially available or FDA approved products. In order for these compounds to be covered, a prior authorizati on must be completed by the prescriber. Unfortunately, someti mes if there is a change in drug strength for the same compound another prior authorizati on must be completed. Someti mes there are clauses for insurance companies stati ng that they have the ability to cover certain compounds.

Resources htt ps://www.healthcare.gov/htt p://www.medicare.gov/htt p://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/understandinggenericdrugs/ucm167991.htmhtt p://www.cms.gov/Outreach-and-Educati on/Outreach/Partnerships/downloads/11522-P.pdf

HOW DOES MY INSURANCE WORK?Hanife Ardolic – Doctor of Pharmacy Candidate Class of 2014

Four Corners Pharmacy

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Holiday Greetings my fellow readers, English dramatist, author; Douglas Adams, stated; “ I love deadlines. I like the whooshing sound they make as they fly by.” I can’t imagine that there are many that feel as Adams did about deadlines when it comes to the holidays of Hannaukah, Christmas & New Year’s. So many activities & expectations...then of course there are those unforeseeable variables of weather, sickness, and lists that often turn this joyous time of year into stress! As part of my Advent lessons with my 5th grade students over the years, I read stories that contained traditional tales, ethnic customs & celebration, as well as modern tales. One in particular stands out. The name of it eludes me, but the message was that the little boy did not want to celebrate Christmas because of the stress that his parents brought to the celebration. He didn’t want perfect cookies, a perfect tree, being dragged to malls, and to hear the bickering in the background as he was rushed & hauled off out of the house visit one more time. I asked my students to write about their true Christmas wishes & memories. I was amazed at how so many of their entries recalled time with family, good food, the preparation for the day, the traditions and the books that went along with the celebration. I always read to my students The Best Christmas Pageant Ever by Barbara Robinson, a true modern day classic as well as a children’s version of A Christmas Carol. We read books of ethnic customs & foods (which of course we had throughout Advent). It was time that often was hard to stay focused on other subjects...but a clever teacher knew how to address that. We have several Christmas children’s books here at the shop, as well as several crafting, cooking Holiday celebration books. I have the Christmas romances featured as well. Christmas carols often started as poems, such as, I Heard the Bells on Christmas Day by Longfellow or The Night Before Christmas by written in 1822 by Clement Moore. I have gathered some quotes from authors regarding Christmas:President Ronald Reagan said; “Christmas can be celebrated in the school room with pine trees, tinsel and reindeers, but there must be no mention of the man whose birthday is being celebrated. One wonders how a teacher would answer if a student asked why it was called Christmas.” I wonder what his thoughts would be now that in many school districts they recognize all religious customs and in others not even the wearing of red & green is allowed! President, Calvin Coolidge said, “Christmas is not a time nor a season, but a state of mind. To cherish peace and goodwill, to be plenteous in mercy, is to have the real spirit of Christmas.” Author Laura Ingalls Wilder said, “Our hearts grow tender with childhood memories and love of kindred, and we are better throughout the year for having, in spirit, become a child again at Christmas-time.” Humorist/author Dave Barry states; “In the old days, it was not called the Holiday Season; the Christians called it ‘Christmas’ and went to

church; the Jews called it ‘Hanukkah’ and went to synagogue; the atheists went to parties and drank. People passing each other on the street would say ‘Merry Christmas!’ or ‘Happy Hanukkah!’ or (to the atheists) ‘Look out for the wall!” To quote the “Grinch” “Christmas doesn’t come from a store, maybe Christmas perhaps means a little bit more....” I so like this final one by J.K. Rowling through the voice of one of her beloved characters from Harry Potter; “One can never have enough socks,” said Dumbledore. “Another Christmas has come and gone and I didn’t get a single pair. People will insist on giving me books.” Of course, I would hope that you would consider books for gift giving. Many of the books here at Tattered Pages are in gift giving quality. I have a huge assortment of cookbooks, crafting books, coffee table books, kids books, novels & non-fiction. A recent new customer asked where I kept the “new” books, recently published. I told her that most of them were on the shelves with the author’s previous published books. She stated, “How would anyone find anything new in here then?” I said, “I have over 19,000 titles in here…if you haven’t read it doesn’t that make it new to you?” Then I showed her 10 newly published books on the shelves! I would like to suggest before venturing off to the mall or big box stores that you give me a call, e-mail me, or message me on Facebook (Tattered Pages, LLC) to see if I have what you are looking for. If I do not, I should be able to get it for you for much less than in the big stores. When you support local business, I get to remain in business! Seems like a win/win to me. If you could remember my bookshop this winter, & tell a friend…just a few more $10 sales could help me greatly, I would be forever grateful, and $10 can buy a few books and more if you have trade credits! You can always make requests for books thru e-mail mytatteredpages@gmail.com or thru www.tatteredpages365.webs.com. I wish all of my readers the warmest wishes for your Holiday celebrations, family times, snowed in days…and if you are looking for a book…stop by, browse, call, e-mail, message me! People go into big box stores for a specific title, but go into a used bookstore to have the books find them. Come on by and see what I have in store for you!

Trish

Patricia Eldridge is the owner of Tattered Pages found at 365 Feura Bush Rd. in The Glenmont Center Square (next to Romo’s Pizza) in Glenmont, NY. #447-9910 Hours: Mon. & Tues. 9:30-5:30, Wed. & Thurs. 9:30-6:30, Fri. 9-7, Sat. 10-5

Trish’s Pix Tattered Pages Used Books