Learn the facts about insurance coverage and access to treatments for heart disease
Deborah D. Gordon has spent her career trying to level the playing field for healthcare consumers. She is co-founder of, the premiere membership organization for independent advocates. She is the author of "The Health Care Consumer's Manifesto: How to Get the Most for Your Money," based on consumer research she conducted as a senior fellow in the Harvard Kennedy School's Mossavar-Rahmani Center for Business and Government.
Being switched off a treatment that is working for you can lead to medical complications, more HCP visits and more trial and error, plus disruptions to everyday life.To navigate health insurance coverage for heart medicines, it helps to understand some basics about how insurers decide which drugs to cover.PBMs negotiate drug prices with drug makers and set lists of drugs a health insurer will cover .
Prior authorization: You have to get the insurer’s permission before they will cover a drug. They review your request to decide if they believe you need the drug and if they think it’s the only or the best option for you. If they deny your request, you can appeal and try to get them to change their decision.
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