“The January Blues”
by the Member and Community Relations Team

As you painfully know, every January payers shift the landscape and HTCs experience many obstacles to their pharmacy program. Benefits, formularies, prior authorizations, and prior authorization processes change. HTCs may lose patients to commercial specialty pharmacies and the narrowing of networks. We know that Alternative Funding Programs are on the rise and many patients have had a Copay-Accumulator or Copay Maximizer Program added to their benefits. The point being, January can give every HTC “the Blues” if they don’t have a plan in place to address these potential changes affecting their patients. We know every HTC has experienced this at some point. If you’re running into any of these issues, please reach out to your primary contact within the Member and Community Relations Team.

Here are examples of some information we may need:

• Copy of insurance card
Identifies who the insurance company is and if it is a fully funded or self-funded plan.
• Have you received an official denial?
If so, what is the reason for the denial? Include a copy of the letter if available.
• Diagnosis and severity?
• What is the product and dosage?

If an issue is affecting your HTC, it may be affecting others. By sharing your experience, we can help each other.