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Tips For Insurance & Cost Management For Dry Eye Disease
When you've been diagnosed with chronic dry eye disease, it's normal to feel overwhelmed. For starters, there are so many possible reasons behind dry eye, and it can take time to find the root cause. There are also myriad treatment options, which you'll likely need to use long term.
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Needless to say, managing the costs associated with dry eye can be challenging. But there's some good news: With the right approach, it's possible to reduce out-of-pocket expenses, potentially making treatment more affordable.
Not sure where to start? Ahead, find tips for handling insurance and managing costs while treating dry eye disease.
Understanding your insurance coverage
Although navigating health insurance can feel like a full-time job, it doesn't need to be that way. Here's how to break down your insurance plan so you can stay in the know.
Review your policy:
Whether your health plan includes vision coverage or you have a separate vision plan, it's important to review your policy. This will help you identify which services and products are covered (and what isn't).
While you're at it, pay attention to sections related to eye care and prescription medication, as they'll apply to your dry eye treatment.
Contact your insurance provider:
If you're still confused after reviewing your policy, don't panic. This is understandable, given the medical jargon and fine print often used in insurance plans.
Instead of staying in the dark, reach out to your insurance provider to clarify any doubts about coverage for dry eye treatment.
Ask about the process for obtaining coverage, covered medications, and necessary documents, if any. And don't forget to take notes!
Know your formularies:
Get to know your insurance plan's formulary, also known as a drug list. A formulary is a list of prescription medications covered by your plan, according to the Health Insurance Marketplace.
For dry eye specifically, "there may be different formulary alternatives within the same classification of dry eye medications," shares Vicky Wong, O.D., optometrist and president of the Maryland Optometric Association. In this case, you and your doc will be able to choose treatments more likely to be covered.
Complete prior authorization:
Depending on the dry eye treatment, your insurance might need to approve prescription medication before covering it.
This is known as a prior authorization, and sometimes, your doctor may be able to request it, says Wong.
Make sure any prior authorizations are in place before picking up your medication. Otherwise, you'll have to pay out of pocket.
Maximizing insurance benefits
To get the most out of your insurance and better manage costs, here's what you can do.
Utilize Flexible Spending Accounts (FSAs):
If you have access to an FSA through your employer, use it to cover eligible eye care expenses with pretax dollars. This may include eye care services and medications, including dry eye treatments.
In turn, you'll be able to reduce how much you pay for medical costs out of pocket.
Take advantage of preventive services:
Many vision plans (or health insurance plans that include vision coverage) include free preventive services. For eye care specifically, the main service is a regular eye exam, which can help identify issues early and prevent more costly treatments later.
So, how often should you get regular eye exams? The exact frequency depends on your eye health, but in general, you'll want to see the eye doc every one or two years, according to the American Optometric Association.
Your eye care provider can recommend the best frequency for you.
Stay in network:
Before seeing an eye care provider, make sure they're in your insurance plan's network—i.e., a group of providers whose services your insurance will help pay for. Similarly, before filling a prescription at a pharmacy, make sure it's in network.
This will help you avoid extra charges and ensure you don't have to pay out of pocket.
Working with your eye care provider
Remember, you and your eye care provider are a team. By taking the time to collaborate, you'll be able to find the most cost-effective treatment possible. Ahead, check out some tips for getting started.
Open communication:
Be honest with your provider about your financial concerns. They can often recommend less expensive alternatives, such as over-the-counter or generic prescription medications.
Plus, "procedure-based dry eye treatment may [sometimes] be more cost effective vs. monthly medication refills," says Wong. Your provider can let you know if you're a good candidate for any procedures and help you compare the costs.
Request a comprehensive treatment plan:
Ask your eye doc for a complete treatment plan, including the expected costs and frequency of medications, potential alternatives, and any necessary tests or procedures.
You can also request specific lifestyle changes for your symptoms, which will help you get the most out of treatment and prevent future issues. Many lifestyle changes are also inexpensive, helping you save you money in the long run.
Regular review:
To ensure you're using the most cost-effective options, regularly review your treatment plan and medication list with your doctor.
This can take place at your routine eye checkups or between appointments, depending on your situation.
Using assistance programs and discounts
When it comes to eye care and dry eye treatment, there are several resources that can help you save money—you just need to know where to look.
Manufacturer assistance programs:
"Some pharmaceutical companies partner with private pharmacies with an assistance program," explains Wong. This can help cover the cost of your medications.
"Additionally, some dry eye pharmaceutical companies have created their own medication distribution within private pharmacies," shares Wong. "It's a way to skip the 'middleman,' which is a cost savings for many patients."
Not sure where to find these programs? Check the manufacturer's website, or ask your doctor.
Prescription discount cards:
These are programs that offer prescription discount cards or coupons, which can save you cash on medications. Typically, these programs require a monthly or annual membership fee, according to the Office of the New York State Attorney General, though some might be free.
If your doctor thinks you'll need long-term dry eye medication, it might be worth signing up for one of these programs.
But take note: These programs have their own network of pharmacies, which might be different from your insurance plan's. Always check before filling a prescription.
Nonprofit organizations:
You might be eligible to receive financial assistance or discounts from certain nonprofit organizations.
Some organizations that might offer financial support include NeedyMeds, EyeCare America, and VSP Vision.
Community resources:
If you live near an optometry college, check if they offer free eye exams. For example, the State University of NY College of Optometry offers free exams and medical tests every month—and there are no eligibility requirements. This can help you get a diagnosis for dry eye or get checked if your symptoms change.
Local community centers and eye care clinics might also provide free or low-cost checkups during certain times of the year.
State and federal programs:
Depending on your income or medical needs, you might qualify for state or federal programs that offer assistance for eye care medication.
Practicing cost-saving strategies
When paying for services or treatments, there are several things you can do to save money.
Use generic medications:
When possible, choose over-the-counter or generic versions of medications, which are often cheaper than their brand-name counterparts.
But be sure to check with your doctor first. Overall, "generic drops are less shelf stable and aren't as effective as brand-name drops," notes Wong. "This is because some medications [have] a suspension base and can separate in the bottle."
Compare pharmacies:
Prices can vary widely between pharmacies, so always compare prices first.
Use online tools like SingleCare and PharmacyChecker to find the best deal for your prescriptions.
Ask for samples:
"Many dry eye treatments are long term since dry eyes are typically chronic and need continued maintenance," says Wong. Thus, it's important to find a medication that works for you.
To do this without wasting money, ask your doctor if they can provide samples of medications. This will give you a chance to try a treatment without the initial cost.
Buy in bulk:
If you have a prescription that you'll need to use regularly, buy in bulk when possible. Not only will this ensure you always have the treatment on hand, but you'll be able to save money too.
When it comes to medications for chronic conditions, many insurance plans allow you to buy enough meds for three months, says Wong. This "is a perfectly appropriate amount of time to stock up for. Any [longer] and you'd lose track of expiration dates," she notes.
Use mail-order pharmacies:
You might be able to score a better deal through mail-order pharmacies. Plus, this option is more convenient, especially for long-term medications.
Conclusion
Let's be real: Treating dry eye disease (or any condition, really) can be hard on your bank account. But by understanding your insurance coverage, using cost-saving strategies, and looking for assistance programs, you can make your treatment more affordable. While you're at it, don't hesitate to talk to your eye care provider about financial concerns. They can point you in the right direction and ensure you get the treatment you need.
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