Open enrollment is an important opportunity to review your health insurance coverage. And, if you or a family member is living with alopecia areata (AA), there are some important questions to consider before choosing a plan. Health plans can differ significantly in the doctors, treatments, and services they cover. A plan with a lower monthly premium may not necessarily be the least expensive option if it provides limited coverage for the care you need. As you compare your options, consider your current and potential future AA healthcare needs. Here are a few questions to ask before enrolling in a new health plan: Is my dermatologist or AA specialist in-network? If you have a healthcare provider you want to continue seeing, confirm that they participate in the new plan. Are my AA medications covered? Check the plan’s drug formulary for any medications you currently take—and understand what you’ll pay for them. Are the other services I need covered? Consider dermatology visits, laboratory testing, cranial prosthesis (wig) reimbursement, mental health services and other care you or your family may need during the year. What if my AA treatment needs change? Alopecia areata can be unpredictable. Consider whether the plan gives you access to specialists and treatment options you may need in the future—not just the care you need today. What are my real out-of-pocket costs? Look beyond the monthly premium. Compare deductibles, specialty copays, prescription costs, coinsurance and annual out-of-pocket maximums. If you are taking a JAK inhibitor or considering starting one in the future, take a few extra steps to ensure your copay is manageable. Are JAK inhibitors covered? Check the plan’s drug formulary. JAK inhibitors are typically considered a specialty medication on most plans. Is my patient assistance program impacted (If using one)? If you’re currently enrolled in a drug manufacturer’s co-pay assistance program for a JAK inhibitor, contact them to determine if anything changes if you change insurance plans. Does the plan require prior authorization or step therapy? Some plans may require additional approval or require you to try other treatments before covering the medication your doctor recommends. Does the plan I am considering use a copay maximizer (also called copay accumulators)? These programs are used by some health plans, and they affect patient assistance programs, especially those that use drug company copay cards. In September 2023, courts ruled that private health plans cannot use copay accumulators for brand-name drugs if there is no suitable generic. However, insurers have not yet caught up with this ruling, so patients must be informed. You can ask your HR/Benefits administrator (if your health plan is employee-sponsored) or call the insurance company’s customer service line and ask if their pharmacy benefits use copay maximizers or copay accumulators – something you’ll want to avoid if you can. Our friends at Crohn’s & Colitis Foundation have more information about these programs. Learn about Copay Maximizers from the Crohn’s & Colitis Foundation Our friends at the Autoimmune Association have created a helpful Quick Guide to Health Insurance that explains insurance basics, what to consider when comparing plans, prescription drug coverage, common insurance terms and how to compare plans side by side. Explore the Autoimmune Association’s Quick Guide to Health Insurance Taking a little extra time during open enrollment to understand your coverage can help you choose a plan that supports not only your general healthcare needs, but also the care you may need to manage alopecia areata throughout the coming year. Other insurance resources from NAAF: Treatment & Insurance Navigation Toolkit Unlocking Access: Understanding Insurance and Patient Assistance Progrma for Alopecia Areata (WEBINAR)
