b'What if you are underinsured? Some people have insurance, but have difficulty accessing care because of high deductibles. Discuss this issue with your providers and your local MS community members. Local charities may assist those with high deductibles, or providers may be willing to work out a payment plan. Generally, what you owe a provider still counts towards your deductible, even if you are paying it over time. This will allow you to satisfy your deductible sooner and get better access to care. Key Resource: Community Health Center Directory - ndahealthcenter.hrsa.gov 2. Fighting for treatments your health plan doesnt want to coverThe decision about which MS medication to use is a weighty one, with signicant implications for your quality of life. That decision should be made by you and your treating physician, based on your needs and personal circumstances. It should not need to be made on the basis of what your insurance covers, but unfortunately, thats too often been the case. How can you access the medications you need? It will require partnership between you and your doctor, working together to challenge the status quo. Access Challenge: New Insurance Carrier When you have a selection of new insurance carriers to choose from, make certain to check the drug formulary and see if your chosen treatment is covered before selecting that plan. But what if you do not have a choice of carriers? For example, what if your employer switches carriers, and the new insurance does not cover the medication that you have been taking for years? In this circumstance, your doctor can request a formulary exception. They may need to write a letter of medical necessity to the carrier and send case notes. The letter would explain that your MS is stable on the medication they are requesting and that it would risk that stability to transfer you to another medication, potentially causing relapses or progression. If the carrier declines, your doctor can request a peer-to-peer review where they can discuss your case with a medical professional at the insurance company.Access Challenge: Switching Medications If the medication you have chosen is not effective for you or causes intolerable side effects, you and your doctor may make the choice to switch medications. A common problem people face when switching is step therapy. Step therapy, also referred to as step edits or a fail-rst policy, dictates the order in which a person should try different treatments. Typically, the insurer requires a person to try lower cost treatments first, and only if those fail to help can the person try the next medicine on the list. Step therapy policies can be particularly harmful to MS patients, because failing a drug means a relapse or disease progression occurred. The damage may be irreversible. The first step in fighting a step therapy policy is for your doctor to request an exception. If you have not tried the medication the insurer is requiring you to try but have tried a medication in the same class, your doctor can make the case that this satisfies the requirement. If you havent tried a similar medication, your doctor will need to explain the reasons why the requested drug is necessary in your individual case. Key Resource: StepTherapy.com: steptherapy.com/how-to-get-involved13'