Common Insurance Challenges & Access Strategies for people with CF Yamini Saxena, MHSA Senior Case Manager, CFF Compass Bethesda Office, MD

Presenter Disclosure Yamini Saxena, MHSA There are no relationships to disclose related to this presentation.

Common Insurance Challenges & Access Strategies for people with CF Find plans where medical deductible is integrated with prescriptions Copay cards may off-set deductible Health Savings Accounts (HSAs) Hospital financial assistance programs Supplemental coverage State-sponsored premium assistance or special health needs program Medicaid through waiver programs Disease-specific non-profits COST BARRIERS Rising marketplace premiums and don’t qualify for subsidies or Medicaid High Deductible Health Plans (HDHP) = ↑ out-of-pocket costs What are the strategies for the first two bullets?

Common Insurance Challenges & Access Strategies for people with CF COST BARRIERS Newly eligible to Medicare Home IV not covered ACCESS STRATEGIES Supplemental coverage Medicare Savings Programs Medicare Extra Help Medicare Supplemental Plans Medicaid through spend-down or waiver programs State-sponsored special health needs program Medicare Advantage plans Dual eligible coverage State-sponsored chronic needs program Outpatient infusion Dept.

Common Insurance Challenges & Access Strategies for people with CF Other options: employer plans, dependent coverage, COBRA Transition of Care or Continuity of Care Apply for network gap exception, peer-to-peer review usually better than written appeal Utilize in-network facilities, at least for diagnostic procedures or lab work ACCESS BARRIERS Coverage for further away or out-of-state care centers Limited plans available Going outside the exchange – losing subsidies to cover care center

Common Insurance Challenges & Access Strategies for people with CF Consider formulary alternative or generic substitute Proactively request formulary exceptions or prior authorizations CoverMyMeds can help facilitate If PA is denied, doctor may submit additional documentation without appeal, or ask for a peer-to-peer review over the phone 72-hour emergency fill If you identify any unreasonable coverage restrictions for CF drugs, communicate to Compass ACCESS BARRIERS Prior authorizations

Common Insurance Challenges & Access Strategies for people with CF ACCESS BARRIERS Requirement to fill enzymes through mail order pharmacies that do not bill copay cards ACCESS STRATEGIES Manual reimbursement with enzyme copay cards Fill through specialty pharmacies

Open Enrollment – Key Dates MEDICARE Oct 15 – Dec 7 MARKETPLACE/INDIVIDUAL PLANS Nov 1- Dec 15 on healthcare.gov Some states have extended the deadline Compass can help people navigate their insurance options; recorded webinar on Port CF

International CF Patients Issues & Access Routes Access to medications and devices such as vests, outside USA US manufacturers do not offer patient assistance outside USA; however, some will allow if patient is being treated by a US physician Manufacturers with global distributors can connect with family Non-profits may provide financial grants, both domestically and globally (e.g., First Hand Foundation) Access to specialized care with physicians who can deliver care for cystic fibrosis Cystic Fibrosis Worldwide has CF clinics listed globally Connect with established CF organizations in neighboring countries that have care models (e.g., UK Trust Fund) Few CF pulmonologists in US willing to provide phone consultation International physicians can join LLC listserv for clinical advice

International CF Patients & Access Issues Assistance in coordinating travel to the United States for treatment Help connect with CFCC who accept international patients Hospital “international coordinator” Must show financial capability Manufacturer patient assistance programs Health insurance marketplace State-sponsored children with special healthcare needs program

Questions? Yamini Saxena, MHSA Senior Case Manager, CFF Compass Bethesda Office, MD