Zimene Mukuyenera Kudziwa
A mankhwala formulary ndi mndandanda wa mankhwala osokoneza bongo, dzina lachibadwa ndi dzina, zomwe zimasankhidwa ndi dongosolo lanu la thanzi. Ndondomeko yanu ya umoyo imangopereka mankhwala omwe ali pa mndandanda uwu "wokondedwa". Kuwonjezera apo, mapulani azaumoyo adzangopereka mankhwala omwe agulitsidwa kugulitsidwa ndi US Food and Drug Administration (FDA).
Cholinga cha mapulani anu a zaumoyo ndikukuyendetsani mankhwala osokoneza bongo omwe amathandiza mokwanira kuti mukhale ndi thanzi lanu.
Mudzabwezera zambiri ngati inu ndi dokotala wanu mumasankha mankhwala omwe sakuphimbidwa pa formulary ya thanzi lanu.
Mapulani a zaumoyo nthawi zambiri amapempha madokotala kuti apereke mankhwala omwe ali mu formulary nthawi iliyonse. Mapulani ambiri azaumoyo ayang'anenso ngati dokotala akugwiritsa ntchito ndondomeko ya thanzi. Ngati sichoncho, ndondomeko yaumoyo ingayankhulane ndi dokotala ndikumulimbikitseni kugwiritsa ntchito mankhwala pa formulary.
A Dr. Mike Tip: Ngati simukumvetsa mapulani a mankhwala anu, mungadabwe ngati mukuyenera kulipira mtengo wogulitsa mankhwala anu.
Ndani Amasankha Mankhwala Osokoneza Bongo?
Muzinthu zambiri zaumoyo, formulary imayambitsidwa ndi komiti ya mankhwala ndi zamankhwala yokhala ndi madokotala ndi madokotala ochokera kuzipatala zosiyanasiyana zamankhwala.
Komiti imakambirana za mankhwala atsopano komanso alipo ndipo amasankha mankhwala kuti aphatikizidwe mu dongosolo laumoyo pogwiritsa ntchito chitetezo komanso momwe amagwirira ntchito.
Komitiyo imasankha mankhwala osapindulitsa kwambiri m'kalasi lililonse lachiritso. Kalasi yothandizira ndi gulu la mankhwala omwe amachiza matenda enaake kapena omwe amagwira ntchito mwanjira inayake. Mwachitsanzo, maantibayotiki amagwiritsidwa ntchito pochiza matenda.
Pansi pa kusintha komwe kunabweretsa ndi Care Affordable Care Act, ndondomeko ya gulu limodzi ndi yaing'ono iyenera kuphatikizapo mankhwala amodzi kuchokera ku US US Pharmacopeia (USP) ndi kalasi, OR chiwerengero chofanana cha mankhwala mu USP iliyonse gulu ndi kalasi monga ndondomeko kachitidwe ka boma, zilizonse.
Kawirikawiri, formulary ikusinthidwa chaka ndi chaka, ngakhale kuti ikusintha chaka chonse. Zosintha zina zimadalira kupezeka kwa mankhwala atsopano, ndipo zina zimachitika ngati FDA ikuwona mankhwala akukhala osatetezeka.
Kodi Phindu Lalipi?
Ndalama yogwirizanitsa ndi gawo lanu la mtengo wa mankhwala, pamene iwo awonedwa ngati ndalama yapadera. Mwachitsanzo, ngati ndondomeko yanu ikugwiritsira ntchito mankhwala a Tier 1 ndi madola 20 a $ 20 ndi madokotala awiri omwe ali ndi ndalama zokwana madola 40, izi ndizo ndalama zomwe mudzalipira mukadzalemba mankhwala, ndipo ndalama zotsalirazo zidzaperekedwa ndi dongosolo lanu labwino.
Kodi Coinsurance ndi chiyani?
Ngati ndondomeko yanu ya umoyo imagwiritsira ntchito ndalama zogwiritsira ntchito mankhwala (zowonongeka kwa mankhwala m'Chigawo cha 4 ndi pamwamba), zikutanthauza kuti mudzalipira kuchuluka kwa mtengo wa mankhwala, m'malo mwa ndalama za ndalama. Choncho ngati mankhwala osokoneza bongo 4 amadzipiritsa $ 1,000 ndipo ndondomeko yanu ili ndi 30 peresenti yolimbikitsira gawo lachinayi, izo zikutanthauza kuti mudzakhala ndi ndalama zokwana madola 300 phindu lanu mukamadzaza mankhwalawa.
Pazifukwa zina - monga MS, mwachitsanzo - mankhwala onse omwe alipo alipo amadziwika kuti ndi mankhwala apadera, omwe amatanthauza kuti ali ndi gawo 4 kapena pamwamba, ndipo ndalamazo zimagwiritsidwa ntchito nthawi zambiri. Zotsatira zake zingakhale zogawanika kwambiri kwa anthu omwe ali ndi inshuwalansi, koma malire onse omwe amalembedwa ndi ACA chifukwa cha ndondomeko ya thanzi pomaliza kutenga 100 peresenti ya mtengo, pokhapokha membalayo atapeza malire ake ogawa mtengo kwa chaka.
Kodi Chigawo cha Formulary ndi chiyani?
Mankhwala pa formulary nthawi zambiri amagawidwa m'zigawo zitatu, ndipo malipiro anu kapena ndalama zanu zimatsimikiziridwa ndi gawo lomwe mankhwala anu ali. Njira yowonjezeramo mankhwala imaphatikizapo magawo anayi kapena asanu. Gulu lochepa kwambiri lidzakhala ndi gawo lochepa kwambiri , kugawanika , pamene mankhwala osokoneza bongo adzakhala ndi magawo opambana kwambiri.
Gawo 1 liri ndi mgwirizano wotsika kwambiri ndipo kawirikawiri umaphatikizapo mankhwala ochiritsira .
Gawo 2 liri ndi malipiro apamwamba kwambiri kusiyana ndi gawo la 1 ndipo lingaphatikizepo mankhwala omwe sali okondedwa ndi / kapena omwe amagwiritsa ntchito mankhwala a dzina la mankhwala.
Gawo 3 liri ndi malipiro apamwamba kwambiri ndipo angaphatikizepo mankhwala osankhidwa kapena osakondedwa omwe amawatchula.
Gawo 4 ndi 5 Mogwirizana ndi ndondomeko yanu, mankhwala anu ogwiritsira ntchito mankhwala osokoneza bongo amatha kukhala pa Gawo 4 kapena 5. Njira yanu yathanzi ikhoza kukhazikitsa mankhwala apamwamba chifukwa ndi atsopano komanso osatsimikiziridwa kukhala otetezeka kapena ogwira ntchito. Kapena, mankhwalawa akhoza kukhala apamwamba kwambiri chifukwa ali ndi mankhwala ofanana ndi omwewo pa tsamba laling'ono la formulary limene lingakupatseni phindu lofanana pa mtengo wotsika. Mankhwala apadera akuphatikizidwa pamwamba kwambiri. Mankhwala osokoneza bongo omwe ali pamwamba amapangidwa ndi coinsurance osati copay, kotero ndalama zanu zopezeka pamtunda uwu zingakhale zapamwamba kwambiri.
Kwa zina mwa mankhwalawa, ndondomeko yanu ya thanzi ikhonza kukambirana ndi kampani yogulitsa mankhwala kupeza mtengo wotsika. Momwemonso, ndondomeko yanu ya thanzi imatchula mankhwala ngati "mankhwala okondedwa" ndipo amachititsa kuti izi zikhale zochepa, zomwe zimapangitsa kuti muzigawana ndalama zochepa.
Ndondomeko yanu yaumoyo ingakupatseni mndandanda wa mankhwala osaphimbidwa ndi omwe muyenera kulipira mtengo wogulitsa. Mndandandawu ukhoza kuphatikizapo mankhwala oyesera, mankhwala osokoneza bongo, ndi mankhwala omwe amadziwika kuti amagwiritsidwa ntchito, monga omwe amagwiritsidwa ntchito pofuna kuchiza matenda ophera erectile kapena kuchepa kwa thupi.
Kodi Mumapanga Zoletsedwa?
Mapulani ambiri a zaumoyo ali ndi njira zothetsera kapena kuletsa mankhwala ena. Izi zachitika pofuna kulimbikitsa dokotala wanu kugwiritsa ntchito mankhwala ena moyenera, komanso kusunga ndalama mwa kupewa mankhwala osokoneza bongo. Zina zowonongedwa ndizo:
Kuvomerezeka kwapadera : Njira yomwe dotolo wanu ayenera kulandira chilolezo kuchokera ku dongosolo lanu labwino kuti mupeze chithandizo cha mankhwala pa formulary. Kawirikawiri, izi ndi mankhwala omwe angakhale ndi chitetezo, amakhala ndi mwayi waukulu wosagwiritsidwa ntchito molakwika, kapena ali ndi njira zowonjezera mtengo pa formulary.
Kusamalidwa kwabwino kwabwino: ndondomeko yomwe dongosolo lanu la thanzi labwino likuyendera mankhwala opatsirana mankhwala asanakwane kuti atsimikizire kuti kuchuluka kwa mlingo ndizomwe zikugwirizana ndi ndondomeko za FDA
Njira yachithandizo : Njira yomwe dongosolo lanu laumoyo likufunira kuti muyambe kumwa mankhwala ena poyesa matenda anu musanayambe kumwa mankhwala ena. Kawirikawiri, mankhwala oyamba ndi otsika mtengo.
Kodi Pali Kusiyana kwa Malamulo Awa?
Ndondomeko yanu yaumoyo ikhoza kutsegulira zochitika zingapo:
- Mukupempha dongosolo kuti muphimbe mankhwala omwe sali pa formulary.
- Mukupempha dongosolo lokhazikitsa malire okhudzidwa kapena malire pa mankhwala anu.
- Mukupempha kuti mupereke mankhwalawa ndi ndalama zambiri zogulira.
Kawirikawiri, dongosolo lanu la thanzi lidzakambirana zapaderazi ngati kusowa kwachithandizo kwa mankhwala anu kungakuchititseni kugwiritsa ntchito mankhwala osagwira ntchito kapena kukupangitsani kuti mukhale ndi mankhwala oopsa.
Ngati pempho lanu lapadera likuchotsedwa, muli ndi ufulu wodandaula. Mapulani onse azaumoyo ali ndi ndondomeko yowunikira, yomwe ingaphatikizepo anthu opanda tsankho omwe sagwiritsidwe ntchito ndi ndondomekoyi. Komanso, ngati pempho lanu likuletsedwa mungathe kusankha dokotala wanu kuti adziwe mankhwalawo, koma inu mudzakhala ndi udindo wodzaza mankhwalawa.
Malangizo Ena ochokera kwa Mike Mike
Dziwani Thanzi Lanu Labwino
Mapulani onse azaumoyo ali ndi mitundu yosiyana siyana, ndipo ndi kofunika kuti mumvetse bwino fomu yanu. Pamene mwalembetsa, muyenera kulandira kabuku kamene kamakamba za formulary ndikulemba mankhwala onse ovomerezeka, komanso kufotokozera za malipiro omwe amagwirizana nawo komanso / kapena ndalama zothandizira. Mukhozanso kupeza mawonekedwe anu pa intaneti. Ngati simunalandire fomu, funsani nambala ya utumiki wa makasitomala pa khadi lanu la mankhwala kuti muwapemphe.
Lankhulani ndi Dokotala Wanu
Ngati mukusowa mankhwala, lankhulani ndi wothandizira zaumoyo wanu ponena za mankhwala ochiritsira kapena mankhwala omwe mumakonda ngati mankhwalawa ndi oyenera.
Sankhani Zaumoyo Wanu Mwanzeru
Ngati muli ndi zisankho zaumoyo ndipo mukusowa mankhwala odwala, muyenera kuyang'ana pazithunzi zosiyana siyana ndikusankha ndondomeko yomwe imakhudza mankhwala anu.
Kusinthidwa ndi Louise Norris.
> Zotsatira:
> Pakati pa Odziwitsa Anthu ndi Kuwunika kwa Inshuwalansi, Zambiri pa Zopindulitsa Zaumoyo Zamtengo Wapatali (EHB) Mapulani,
> Chithandizo cha Medicare ndi Services Medicaid, Chidziwitso Chotsatira cha Kupindula ndi Malipiro Omwe Amalipira a 2016