A patient with rheumatoid arthritis (RA) comes to your office and needs a medication. You prescribe it, and the patient’s insurance plan covers it. The patient begins the medication and slowly but surely feels better.
Explore this issueOctober 2018
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Prescribing drugs for a patient should be this simple but rarely is, thanks to the high cost of drugs and the variance in what insurance plans or Medicare cover.
Rheumatologists face questions about drug costs every day, and they are not always easy to answer. “Not infrequently, patients will ask if a drug is covered by their formulary,” says Allan Gibofsky, MD, Hospital for Special Surgery, and professor of medicine, Weill Cornell Medical College, New York. “When I make a drug decision, I may find out from the patient or staff that the drug is not covered, and we then look to prescribe something else. Sometimes that’s acceptable; sometimes it’s problematic, and we have to go through the appeals process.”