Mungathe kudzipulumutsa nokha kusunga ndalama pa mtengo wa mankhwala osokoneza bongo
Ngati muli ndi chithandizo chamankhwala cha mankhwala omwe adokotala anu akukuuzani, mufuna kudziwe bwino ndi kampani yanu ya inshuwalansi, Medicare kapena kachitidwe ka mtengo wogulitsa mankhwala omwe amatchedwa formulary .
Udindo wa mankhwala mu chiwerengero cha mitengo yoyamba mtengo udzapanga kusiyana kwakukulu kwa ndalama zonse zomwe mumagwiritsa ntchito mankhwala.
Kodi Makhalidwewa ndi Chiyani?
Wopereka ndalama, kaya ndi kampani ya inshuwalansi yapadera, Medicare, Tricare, Medicaid kapena pulogalamu ina imakhala ndi mndandanda wa mankhwala omwe adzalipira omwe amatchedwa formulary.
Mankhwalawa amapangidwa ndi mankhwala ochizira, mankhwala osokoneza bongo komanso nthawi zina mankhwala osokoneza bongo (OTC) omwe kale anali mankhwala okhaokha. Mwachitsanzo, Prilosec ndi Naproxen ankakonda kukhala mankhwala okhaokha, koma onsewa tsopano ndi OTC mankhwala. Mapulani ena amapereka Prilosec ndi Naproxen mu formularies zawo.
Kodi Ndizochita Ziti Zomangamanga?
Amagulu ndi magulu a mankhwala amene amagwera mkati mwa mafotokozedwe ndi magulu a mitengo:
- Gawo 1 kapena Gawo Woyamba: Mankhwala amodzi a katatu nthawi zambiri amapezeka mankhwala osokoneza bongo , otsika mtengo mankhwala osokoneza bongo. Nthaŵi zina zina, mankhwala osokonekera amtengo wapatali omwe amagwiritsidwa ntchito nthawi zonse amatha kugwera m'banjamo, nayenso. Mankhwala osokoneza bongo amatitengera ife otsika kwambiri, makamaka $ 10 mpaka $ 25.
- Gawo 2 kapena Gawo Lachiwiri: Gawo lachiwiri limakhala ndi dzina la mankhwala kapena mankhwala okwera mtengo. Ngati mukuyenera kutengera mankhwala , dzina lanu limakhala ndi mndandanda wa mankhwala omwe amawakonda (chifukwa mtengo wawo ndi wochepa, wofotokozedwa pansipa.) Makina opangidwawa amapezeka mu Gawo lachiwiri lachiwiri la mankhwala amatisokoneza -pay, kawirikawiri $ 15 mpaka $ 50.
- Gawo 3: kapena Gawo III: Dzina loposa mankhwala, ndipo kawirikawiri amene kampani yanu ya inshuwalansi sakufuna kuti mupeze mankhwala (chifukwa ndalama zawo ndizitali, zofotokozedwa m'munsimu) zimatengedwa kuti sizinasankhidwe. Iwo amapezeka mu Gawo lachitatu la mankhwala osokoneza bongo amatitengera ife mochulukirapo kuposa ochepa, omwe amawononga ndalama zokwana madola 25 mpaka $ 75.
- Gawo lachinayi kapena gawo lachinayi, lomwe limatchedwanso mankhwala apadera: Izi nthawi zambiri zimangotengedwa ndi mankhwala osokoneza bongo, ndipo ndi okwera mtengo kwambiri moti wothandizira wanu amafuna kufooketsa mankhwalawa. Gawo lachinayi ndilo dzina latsopano, loyamba kugwiritsidwa ntchito mu 2009.
Malemba achinayi omwe akuwoneka ngati akugwiritsira ntchito mankhwala osokoneza bongo. M'malo mogawira ndalama zothandizira ndalama, olipidwa amapereka gawo, monga 60%. Mwachitsanzo, mankhwala osokoneza bongo otchuka kwambiri, okwera mtengo pa $ 1,000 angapereke ndalama $ 600.
N'chifukwa Chiyani Mankhwala Ogwiritsira Ntchito Mankhwala Amaikidwa M'magulu Awo?
Ili ndi yankho lokha la funsoli: ndalama.
Mndandanda wa mankhwalawa ndi ntchito ya zinthu ziwiri: mtengo wake weniweni ndi mtengo wogwirizanitsa. Kuwonjezera apo mankhwalawa amapereka wothandizira olipira, apamwamba kwambiri, ndipo zambiri zimadula odwala.
Mankhwala osiyana m'kalasi lililonse la mankhwala amalembedwa m'magulu osiyanasiyana. Mwachitsanzo, kalasi ya mankhwala omwe amathandiza anthu omwe ali ndi HIV (matenda opatsirana pogonana) amatchedwa proton pump inhibitors, kapena PPIs. Chipangizo cha PPI chosawonongeka kwambiri ndi cha generic, chotchedwa omeprazole, ndipo nthawi zonse chimapezeka m'Chigawo Chachitatu. Zina mwa mapepala opangidwa ndi mtengo wapatali, monga Prilosec kapena Prevacid, amalembedwa m'Chigawo chachiwiri. Ma PPI okwera mtengo kwambiri, monga Aciphex kapena Nexium , alembedwa pa Gawo III.
Pogwiritsa ntchito PPI chitsanzo pamwambapa: Wopereka akhoza kukambirana mtengo wake ndi wopanga kapena wogawira wa mankhwala oposa mtengo, monga Aciphex kapena Nexium mpaka otsika kwambiri. Ngati atayesetsa kuchita zimenezi, mankhwalawa amakhala "mtundu wotchuka," umene umatanthauza kuti umakhala mankhwala osokoneza bongo. Ngati sangakwanitse kukambirana nawo mokwanira, idzaikidwa mu gawo lachitatu ndipo izi zidzawonongetsa odwala ambiri.
Kodi Malipiro Onse Amagwiritsira Ntchito Tizigawo Zomwezo?
Ayi, onse omwe amawalipira salemba mndandanda womwewo ndi mankhwala omwewo. Monga mwafotokozeredwa, gawo la womalipira liyenera kudalira ndalama zake. Ngati Wothandizira A akhoza kukambirana mtengo wotsika wa mankhwala enaake kuposa Payer B negotiates, ndiye Wowonjezera A akhoza kulemba chizindikirochi pa Tier II pamene Wowonjezera B akhoza kulembetsa pa Gawo III.
Kodi Ndingapeze Bwanji Wathandi Wanga wa Inshuwalansi?
Wopereka chithandizo chilichonse chamankhwala adzakupangitsani kuti akupezeko - akufuna kuti mukhale nayo ndikuigwiritsa ntchito. Zidzakhala mosavuta pa webusaiti yathu, kapena mukhoza kuitanitsa nambala ya utumiki wa makasitomala ndikuwapempha kuti atumize kwa inu.
Si zachilendo kwa wolipira kuti apange kusintha kwa formulary kapena kusuntha mankhwala kuchokera pamtunda umodzi kupita ku wina. Ngati mutenga mankhwala tsiku lililonse kapena nthawi zonse, mungadziwitse pamene kusintha kukuchitika. Komanso, mungafune kufufuza kawiri chaka chilichonse pamene mukulembetsa, pamene muli ndi mwayi wopanga ndondomeko yanu yowunikira, kuti muwone ngati mankhwala anu asinthira malo ake mu olemba a formulary.
Kodi Mungatani Kuti Muzisunga Ndalama Pogwiritsa Ntchito Mphoto Yanu?
Ngati muli ndi chidziwitso choyamba cha mankhwala osokoneza bongo komanso mitengo yazing'ono, mukhoza kugwira ntchito ndi dokotala kuti musankhe mankhwala omwe angakuchititseni kuchepetsa. Bwerezani kalasi ya mankhwalawa, ndipo mupeze malo ake mu formulary yanu kuti mutsimikizire kuti mukupeza mankhwala omwe mukusowa ndalama zing'onozing'ono.