Day: February 6, 2024

The American dream promises opportunity and prosperity for all, yet the reality holds a starkly different picture. While some individuals navigate life with relative ease, accessing quality healthcare, healthy food, and safe housing, others face an uphill battle against a powerful and often invisible enemy: social determinants of health (SDOH). 

These non-medical factors, encompassing the circumstances in which we are born, live, work, and age, profoundly impact our health and well-being, weaving a complex tapestry of inequities that disproportionately burden specific populations.

Uneven Playing Field: Racial and Ethnic Minorities

For communities of color in the united states, the deck is often stacked against themand it has resulted in persistent socioeconomic disparities, with a higher prevalence of poverty, unemployment, and lack of health insurance compared to their white counterparts.

These factors translate into tangible risks – living in neighborhoods burdened by environmental hazards like pollution and food deserts, lacking access to quality healthcare, and navigating a system plagued by implicit bias. 

The consequences are stark: higher rates of chronic diseases like heart disease, diabetes, and certain cancers cast a long shadow over individual lives and communities.

Caught in the Crosshairs: Low-Income Individuals and Families

Financial insecurity casts a long shadow, weaving stress, anxiety, and unhealthy coping mechanisms into the fabric of daily life for low-income individuals and families. 

The struggle to make ends meet often compromises healthy food choices, forcing families to rely on processed options loaded with sugar and unhealthy fats. 

Housing instability adds another layer of vulnerability, exposing residents to unsafe living conditions and environmental hazards. Access to healthcare becomes a constant hurdle, with limited insurance coverage or geographical barriers impeding timely diagnosis and treatment.

The cumulative effect? Increased susceptibility to preventable diseases, exacerbating existing health conditions, and perpetuating a vicious cycle of ill health and economic hardship.

Rural Realities: Challenges Beyond the City Limits

For those residing in rural America, healthcare deserts pose a significant challenge. The shortage of healthcare providers and specialists, particularly in mental health and specialized care, creates a daunting obstacle for those seeking essential services.

Transportation barriers add another layer of complexity, forcing long-distance journeys just to access basic healthcare. Access to healthy food can be limited, with grocery stores few and far between, and fresh produce often prohibitively expensive. 

These factors contribute to higher rates of obesity, chronic diseases, and mental health issues, highlighting the need for targeted interventions and increased resource allocation to meet the unique needs of rural communities.

Vulnerable Beginnings: Children and Adolescents Facing an Unequal Start

The consequences of SDOH are tragically evident in the lives of children and adolescents. Growing up in environments characterized by poverty, food insecurity, exposure to violence, and inadequate education puts them at a significant disadvantage. 

These factors negatively impact their physical and mental health development, increasing the risk of chronic diseases, behavioral problems, and academic struggles. 

Early intervention and targeted programs are crucial to break the cycle of intergenerational poverty and ill health, providing vital support during these formative years and ensuring all children have the opportunity to reach their full potential.

Beyond Awareness: Building a More Equitable Future

Recognizing the unequal playing field created by SDOH is the first step towards a more just healthcare system. However, awareness alone is insufficient. 

Concrete action is needed, demanding a multi-pronged approach that tackles disparities at their root:

Policy Advocacy: 

Championing policies that address SDOH by promoting economic equity, ensuring access to quality healthcare and healthy food, and investing in community-based initiatives that empower underserved populations.

Community Engagement: 

Partnering with local organizations and community leaders to identify specific needs and develop culturally tailored interventions that address health challenges within specific populations.

Public Education: 

Raising awareness about the impact of SDOH and promoting individual and collective action to dismantle discriminatory practices and advocate for systemic change.

Learn How Qualify Health Can Help

Qualify Health works with healthcare systems across the country to help solve the health equity crisis. We are a prestigious organization that promotes health equity and reduces health disparities.

We do this via different means which include insurance payments for patients, transportation assistance, and philanthropic solutions to patient medical bills. These solutions help to improve people’s overall health and well-being regardless of their socioeconomic status.

For more information about our services, contact Qualify Health at (888)770-7191

Conclusion

By acknowledging the intersection of SDOH and specific populations, we can move beyond mere statistics and delve into the lived experiences of those facing immense challenges. This deeper understanding fuels our commitment to dismantling the invisible barriers

Given the high cost associated with most prescription drugs, it’s not surprising that many people choose not to fill a prescription or take it as directed in order to save money. A report from NCHS researchers discovered that about 8% of adult Americans do not adhere to their medications as prescribed because they cannot afford them. 

As prescription drug prices keep rising, drug manufacturers have designed ways to reduce the out-of-pocket costs for patients. One way they do this is with copay cards. These cards help insured patients afford expensive prescription drugs that physicians determine are the best treatment options, especially when their insurance doesn’t cover everything. 

Copay cards are not linked to financial need and can help reduce the total expenses for patients. Here’s everything you need to know about using copay cards to get your prescription drugs. 

What are Copay Cards?

Copay cards are a form of cost sharing.  Drug manufacturers use them to help patients offset the responsibility that is left over after insurance. These cards, also called discount cards, copay coupons, copay savings programs, or copay assistance programs, are provided by drug manufacturers directly to all commercially eligible patients. They usually apply to costly, brand-name medications that do not have a generic alternative.

When you present one of these cards at the pharmacy for your medications, your health insurance pays some of the cost.  With copay cards, the manufacturer will cover the rest. They can be especially beneficial for those requiring expensive specialty drugs to treat their condition.

How does Copay Cards work?

According to research by USC Schaeffer, 79 percent of brand-name drugs do not have a generic alternative available, which makes copay cards a valuable resource for patients requiring help affording these medications for treatment. If a patient has commercial insurance, they may have the opportunity to obtain certain brand-name medications for a minimal (or zero) fee using a copay card.

The copay cards carry billing details used by the pharmacy when filling the medication. The pharmacy will process the card’s billing along with the patient’s insurance to offer a discount or credit towards their out-of-pocket expenses.

However, your health insurance company and the manufacturer that cover part or all of the cost you’re responsible for, have a cap on the amount they pay towards out-of-pocket costs per fill (e.g., max $150 per fill).

Where do you use Copay Cards?

Copay cards, designed to be used along with your commercial insurance plan, are accepted at most pharmacies, including online, physical, or mail-order ones, as long as they offer billing services.

How does one get a Copay Card?

For a copay card available for your brand-name medication, there are several ways to get one.

1. You have the option to ask your pharmacist or healthcare provider regarding copay cards for your medications. 
2. You can access copay cards through the medication or manufacturer websites. It’s important to note that the website is usually the quickest and easiest way to acquire a copay card if you are not given one by your provider.
3. Your prescribing doctor may have access to copay cards if they often prescribe a specific type of medication. (e.g., a specialist in diabetes treatment may provide copay cards for particular diabetes medications).
4. You can ask your pharmacist about the availability of a manufacturer copay card for your medication.
5. You can visit the non-profit site to locate the drug manufacturer‘s contact info.

How do you use Copay Cards?

To use a copay card, here are the steps:

1. You can get a copay card from your provider, or pharmacist, or by signing up on the drug manufacturer’s website.
2. Show your copay card to your pharmacist promptly after your medication is prescribed. Copay cards work like insurance and are billed before your medication is filled. If you wait until you pick up your medication to present the card, the pharmacy will need to re-bill it, which can cause delays.
3. Your pharmacy will charge the medication to your commercial health insurance plan, which typically covers most of the medication’s cost. Afterward, the copay card will step in to cover some or all of your remaining copay.

What is the duration of validity for the card?

When you choose these copay card programs, the company issuing the card has specific parameters that determine its expiration. For many copay cards, there is an expiration date and a maximum savings limit. The specifics vary depending on the medication or companies, but generally, there is a monthly or annual maximum. 

Some copay cards also have limits on how many times you can use them. Also, there may be laws that limit the use of specific copay cards depending on your location. In 2017, California prohibited the use of coupons in purchasing brand-name medications that have generic alternatives.

What are the requirements to get this card?

For most of the copay cards, there are two main requirements:

1. You must have commercial or private insurance.

2. You cannot have government health insurance, such as Medicaid or Medicare.

This restriction is enforced by anti-kickback statutes, which prevent manufacturers from inducing the purchase of items that could potentially be reimbursed by the federal government.

Do Copay Cards exist for every kind of medicine?

It’s important to note that copay cards are not available for every type of medication on the market. Typically, you will most likely find copay assistance programs for medications that are costly and relatively new to the market. 

Also, you may encounter a copay card for a branded drug that has not been available for some time, especially if the patent for the drug recently expired and a generic or more cost-effective alternative is now accessible.

How do you redeem the Copay Card?

To redeem these cards, the patients must present them along with their prescriptions to the pharmacist. The pharmacist then enters the details into the system to process a claim.

Once all the necessary information is logged, the patients receive immediate coverage details, indicating their out-of-pocket expenses or co-pay. The details are shared with the benefit manager of the secondary insurance company, who then implements the discount. Finally, the pharmaceutical company covers the program cost, including any difference in the patient’s expenses.

Overall, copay cards help people save significant amounts of money when they require it most. Medical emergencies can unexpectedly arise at any stage of life, posing financial challenges.

How do patients and healthcare professionals benefit from Copay Assistance Programs?

Copay Assistance Programs lessen the patient’s financial burden, making it easier for them to obtain their prescription and ensure that the appropriate treatment is attainable.

Qualify Health specializes in the management of Copay Card programs. Our dedicated staff partners with clients ranging from small oncology practices to the country’s largest healthcare systems. Our Support Service team enrolls the patient into the Copay Card Program, monitors and submits EOBs with patient out-of-pocket expenses, and follows-up on any denials to ensure payment is received promptly. Ultimately, increasing patient satisfaction and reducing the financial burden on the provider’s office or facility by guaranteeing patient out-of-pocket expenses are obtained, which reduces bad debt and increases revenue.