Okudingeka Ukwazi
I-formula formulary uhlu lwezidakamizwa zemithi kadokotela, kokubili igama lomkhiqizo kanye negama, okukhethwa yicebo lakho lempilo. Uhlelo lwakho lwezempilo lungakhokha kuphela imishanguzo ekhona kulolu hlu "olukhethwe". Ukwengeza, izinhlelo zezempilo zizokhokhela kuphela imithi eye yavunyelwa ukudayiswa yi-US Food and Drug Administration (FDA).
Injongo ye-formulary yepulani yakho yezempilo kumele ikuqondise emithini ebiza okungenani ebiza kakhulu okwelapha isimo sakho sempilo.
Uzokhokha ngaphezulu uma wena nodokotela wakho ukhetha imithi engafihliwe kwifomula yakho yezempilo.
Izinhlelo zezempilo zivame ukucela odokotela ukuba banikeze imithi ehlanganiswe kwifomula uma kunokwenzeka. Izinhlelo eziningi zempilo zibukeza ukuthi ngabe udokotela usebenzisa yini uhlelo lwezempilo lwezempilo noma cha. Uma kungenjalo, uhlelo lwezempilo lungabonisana nodokotela futhi lukhuthaze ukuba asebenzise imithi kwifomula.
A Dr. Mike iphuzu: Uma ungaqondi izinzuzo zezidakamizwa zepulani lakho, ungase umangale uma kufanele ukhokhe izindleko ezigcwele zokuthengisa zokuthenga kwakho.
Ubani Okhetha Izidakamizwa Ku-Formulary?
Ezenzweni eziningi zempilo, i-formulary yenzelwa ikomidi lekhemisi kanye nezokwelapha ezakhiwa ngamakhemikhali kanye nodokotela abavela ezifundweni ezihlukahlukene zezokwelapha.
IKomidi ihlola imishanguzo emisha futhi ikhona futhi ikhetha izidakamizwa ukuba zifakwe kwi-formulary yepulani yezempilo ngokusekelwe ekuphepheni nokuthi isebenza kahle kangakanani.
Ikhomishana ikhetha izidakamizwa ezisebenzisekayo kakhulu eklasini ngalinye lezokwelapha. Isigaba sokunakekela i-group of medicines esiphatha isimo esithile sezempilo noma esisebenza ngandlela-thile. Isibonelo, ama-antibiotics asetshenziselwa ukwelashwa kwezifo.
Ngaphansi kwezinguquko ezilethwa yi-Care Act, izinhlelo zamanye amaqembu nezincane kumele zihlanganise okungenani umuthi owodwa kusuka esigabeni ngasinye se-US Pharmacopeia (USP), noma inombolo efanayo yezidakamizwa esigabeni ngasinye se-USP kanye nekilasi njengendlela yokuhlelwa kwamabonakude, noma yikuphi okukhulu.
Ngokujwayelekile, i-formulary ibuyekezwa minyaka yonke, nakuba ingashintsha unyaka wonke. Ezinye izinguquko zixhomeke ekutholakaleni kwemithi emisha, kanti ezinye zenzeka uma i-FDA ibona ukuthi izidakamizwa zingaphephile.
Kuyini Ukukhokhelwa Kwezimali?
Ukukhokha ngokuhlanganyela kuyisabelo sakho sezindleko zemithi kadokotela, uma kukhethwe njengesamba se-flat-dollar. Isibonelo, uma uhlelo lwakho luhlanganisa izidakamizwa ze-Tier 1 nge-$ 20 yokukhokhwa kwemali kanye nezidakamizwa ze-Tier 2 nge-$ 40 yenkokhelo, lezo yizinkokhelo oyozikhokhela uma ugcwalisa umuthi, kanti izindleko ezisele zikhokhwa uhlelo lwakho lwezempilo.
Kuyini ukuQinisekisa?
Uma uhlelo lwakho lwezempilo lusebentisa i- coinsurance ye-coverage yokubhalisa (ejwayelekile kakhulu kwizidakamizwa ku-Tier 4 nangaphezulu), kusho ukuthi uzokhokha iphesenti yezindleko zomuthi, kunokuba isamba semali ye-copay. Ngakho-ke uma umuthi wesi-4 ubiza i-$ 1,000 futhi uhlelo lwakho lunama-30% we-coinsurance ye-Tier 4, okusho ukuthi uzoba necala lika-$ 300 lemali uma ugcwalisa umuthi.
Kweminye imibandela - njenge-MS, isibonelo - zonke izidakamizwa ezitholakalayo zibhekwa njengezidakamizwa ezikhethekile, okusho ukuthi zivame ukuthi ziyiNqanaba 4 noma ngaphezulu, futhi ukugcinwa kwemali kusebenza njalo. Umphumela ungabelana kakhulu ngezindleko ezikhokhelwayo, kodwa umkhawulo ophelele we-pocket owenziwe umphumela we-ACA ohlelweni lwezempilo ekugcineni uqoqe amaphesenti angu-100 ezindleko, uma ilungu lihlangabezane nomkhawulo wakhe wokwabelana ngezindleko ngonyaka.
Uyini umthamo we-Formulary?
Izidakamizwa e-formulary zivame ukuhlanganiswa zibe yizintambo, futhi ukukhokhelwa kwakho noma ukukhokhelwa kwemali kunqunywe yi-tier ukuthi imithi yakho ivuliwe. I-formula ejwayelekile yezidakamizwa ihlanganisa izingxenye ezine noma ezinhlanu. I-tier ephansi kunazo zonke izoba nokwabiwa kwezindleko eziphansi kunazo zonke, kanti izidakamizwa ezingxenyeni eziphakeme kakhulu zizoba nokwabelana okubiza izindleko.
Isigaba 1 sinokukhokhelwa kokubambisana okuphansi kakhulu futhi ngokuvamile kuhlanganisa imithi ejwayelekile .
Isigaba sesi-2 sinokukhokha okubambisene okuphezulu kunokwesigaba esingu-1 futhi singabandakanya ama-generic angakhethiwe kanye / noma imithi yokwazisa igama lomkhiqizo.
Isigaba sesi-3 sinokukhokhelwa kokubambisana okungaphezulu nakakhulu futhi singabandakanya imithi ekhethwa igama noma igama elingelona elithandwayo.
Isigaba 4 no-5 Ngokuya kwepulani, izidakamizwa zakho ezibiza kakhulu ziyobe zikhona kuMgudu wesi-4 noma 5. Uhlelo lwakho lwezempilo lungabeka imithi emphakathini ophezulu ngoba ungakafiki futhi ungabonakali ukuthi uphephile noma usebenza kahle. Noma-ke, imithi ingase ibe esinqumweni esiphakeme ngoba kukhona umuthi ofanayo kumuntu ophansi we-formulary ongakunika inzuzo efanayo ngezindleko eziphansi. Izidakamizwa ezikhethekile zifakwe emkhakheni ophakeme kakhulu. Izidakamizwa ezingxenyeni eziphezulu zivame ukumbozwa nge-coinsurance esikhundleni se-copay, ngakho-ke ukuphuma kwakho kwepokhethi kubiza kulezinga kungaba phezulu kakhulu.
Kweminye yalezi zidakamizwa, uhlelo lwakho lwezempilo lungase luxoxisane nenkampani yezokwelapha ukuthola intengo ephansi. Ngokubuyisela, uhlelo lwakho lwezempilo lubeka imithi ngokuthi "imithi ekhethiwe" futhi ngaleyo ndlela yenza kube khona emkhakheni ophansi, okuholela ekunikezeni izindleko eziphansi.
Uhlelo lwakho lwezempilo lungakunikeza futhi uhlu lwemithi engahlanganisiwe nokuthi kufanele ukhokhele inani eligcwele lokudayisa. Lolu hlu lungabandakanya imithi yokuhlola, imishanguzo ngaphezulu, kanye nezidakamizwa okuthiwa zendlela yokuphila, njengalezo ezisetshenziselwa ukwelapha ukukhubazeka kwe-erectile noma ukulahlekelwa isisindo.
Ingabe ama-Formularies anenoma yiziphi izivimbelo?
Iningi lemishanguzo yezempilo lemiphakethe inezinqubo zokukhawulela noma ukuvimbela imithi ethile. Lokhu kwenziwa ukukhuthaza udokotela wakho ukuba asebenzise imithi ethile ngokufanele, kanye nokugcina imali ngokuvimbela imithi ngokweqile. Ezinye imikhawulo evamile zibandakanya:
Ukugunyazwa Ngaphambi Kokuqala : inqubo udokotela wakho kumele athole imvume kusuka ohlelweni lwakho lwezempilo ukuze uthole ukukhokhelwa kwemithi kwifomula. Ngokuvamile, lena imithi engase ibe nenkinga yokuphepha, ibe namandla okusebenzisa okungalungile, noma ibe nezindlela ezingezansi ezithengisiwe kwifomula.
Ukunakekelwa Kwekhwalithi Yekhwalithi: inqubo lapho uhlelo lwakho lwezempilo luhlola imithi kadokotela ngaphambi kokuba igcwaliswe ukuqinisekisa ukuthi ubungakanani nomthamo uhambisana nezincomo ze-FDA
I-Step Therapy : inqubo lapho uhlelo lwakho lwezempilo ludinga ukuthi uzame okokuqala imithi ethile yokwelapha isimo sakho sempilo ngaphambi kokusebenzisa omunye umuthi waleso simo. Ngokujwayelekile, imithi yokuqala ayigugu kakhulu.
Ingabe Kukhona Okungafani Nale Mithetho?
Uhlelo lwakho lwezempilo lungase luvulekele ukwenza okungafani nezimo eziningana:
- Ucela uhlelo lokumboza imithi engekho kwifomula.
- Ucela lohlelo ukuthi luyekeze imingcele yokuqapha noma imingcele emithini yakho.
- Ucela lo mgomo ukuhlinzeka ngemithi ngokukhokha okunye okungabizi kakhulu.
Ngokuvamile, uhlelo lwakho lwezempilo luzocabangela lokhu okungafani uma ukungabi nokutholakala kwemithi yakho kungaholela ekusebenziseni isidakamizwa esingaphansi komuthi noma kubangele ukuba nomcimbi wezokwelapha owingozi.
Uma isicelo sakho sehlukile siphenduliwe, unelungelo lokukhalaza leso sinqumo. Zonke izinhlelo zezempilo zinenqubo yokukhalaza, engabandakanya abantu abangakhethi abangaqashiwe nguhlelo. Ngaphezu kwalokho, uma isikhalazo sakho sinqatshiwe ungasakhetha ukwelashwa udokotela wakho, kodwa uzoba nesibopho sokukhokhiswa okugcwele kwesidakamizwa.
Iseluleko esivela kuDkt Mike
Yazi i-formula yakho ye-Health Plan
Zonke izinhlelo zezempilo zinamafomula ahlukile, futhi kubalulekile ukuba uqonde ifomula yakho yepulani. Lapho ubhalisile, kufanele uthole incwajana echaza ifomula bese ubhala yonke imithi evunyiwe, kanye nencazelo yezinkokhelo zokubambisana kanye / noma ukuqinisekiswa kwemali. Ungaphinde ufinyelele i-formulary yakho ye-intanethi ku-intanethi. Uma ungakamukelanga ifomula, shayela inombolo yesevisi yamakhasimende kwikhadi lakho lezidakamizwa ukucela eyodwa.
Xoxa nodokotela wakho
Uma udinga umshwalense, khuluma nomhlinzeki wakho wezempilo mayelana nokuchaza umuthi ojwayelekile noma igama lomuthi elikhethwa uma lifaneleka isimo sakho sempilo.
Khetha uhlelo lwakho lwezempilo ngokuhlakanipha
Uma unesiphakamiso sezinhlelo zempilo futhi udinga imithi yesifo esingapheli, kufanele ubheke ama-formulary ahlukene bese ukhetha uhlelo oluhlanganisa imithi yakho.
Kubuyekezwe nguLouise Norris.
> Imithombo:
> Isikhungo Sokwaziswa Komthengi kanye Nokuqapha Umshuwalense, Ulwazi Lwezinzuzo Zezempilo Ezingundoqo (EHB),
> Isikhungo seMedare kanye neMisebenzi yeMedicaid, Isaziso sokugcina seNzuzo kanye neMigomo yokukhokha ka-2016