Before I begin this post I want to make it clear that I do NOT in any way work for the manufacturer (Teva) of the newest albuterol inhaler known as the ProAir® RespiClick. I haven’t been paid to write this blog post. And if you happen to see any ads for the ProAir RespiClick on this website it is entirely the result of the Google Ad program (they randomly place ads) over which I have no control. But although I do not work for Teva, I DO work for my patients. I like to think I work pretty hard for them too. And every once in a while a truly good deal comes along from a manufacturer to help patients obtain their product at reasonable price.
Note, if you just want to PRINT my handy cheat-sheet which summarizes the processing info below, CLICK HERE.
There are currently just 4 albuterol rescue inhaler products on the market: ProAir HFA, Ventolin HFA, Proventil HFA and now the ProAir Respiclick. All of them, if you had to pay the full price yourself, are pretty expensive in my opinion. The difference with the new ProAir Respiclick is that it is “breath activated.” This is important for many asthma and COPD patient for whom the hand-breath coordination necessary to obtain the full dose creates a challenge. Simply put, some patients waste much of the dose of the HFA inhaler because it is hard to properly time the “puff” and the “inhalation” in a way that helps it to work at its best.
ABOUT THE RESPICLICK:
The ProAir RespiClick eliminates the need for such hand-breath coordination. You don’t have to shake it, prime it or (routinely) clean it. You just open the lid (you will hear a click) then put the inhaler to your mouth and breath in. The albuterol is delivered via a fine powder. Those are abbreviated instructions, and patients who have the RespiClick should follow the specific dosing directions as provided on the label and/or box.
This post isn’t really about the pharmacology of how albuterol works or even about the superiority of one inhaler over the other. It is strictly about a good price that is available right now for most patients, EVEN if your insurance doesn’t cover the RespiClick. The information that follows is really intended for pharmacists and technicians who will understand how the billing (and split-billing) process works in pharmacy. I assume a basic knowledge of third-party processing. If you have questions about the following, feel free to shoot me an email.
I. GET A FREE PROAIR RESPICLICK:
It is possible to get a FREE ProAir RespiClick trial through the use of a coupon that is frequently distributed directly to pulmonology offices but might be distributed to some pharmacies too. These coupons have the usual BIN, PCN, Group and ID number and are for 1 TIME ONLY. If you don’t have any such coupons at your pharmacy (or if you are not allowed to see drug reps) you might want to try contacting a local pulmonology office and see if they happen to have the contact info for your local Teva rep. Maybe you could meet for coffee and he/she could hook you up with some of these coupons?
II. GET A DISCOUNTED PROAIR RESPICLICK (Up to 3 Fills):
If the free trial is not available, or if you have already used the free trial for a patient, then there is a great coupon right now that can help bring down the copay for BOTH commercially insured and Medicare patients. The nice thing about this coupon is that it is the SAME processing information for everyone.
Here is the ProAir RespiClick Processing Information:
Depending on the type of insurance the patient has, they may be able to lower their copay to $15 (many plans have much higher copays). How, exactly, you use this processing information depends on whether the ProAir RespiClick is actually covered or not. Here is how it works:
A. COMMERCIALLY INSURED PATIENTS (2 situations):
1. ProAir Respiclick COVERED but Copay > $15? Run the above processing information as a secondary insurance. This is sometimes referred to as a “split bill” or “dual bill.” If you don’t know how to do this, talk to your software vendor or help desk. The copay should be reduced to $15.
2. ProAir Respiclick NOT covered. It is possible another albuterol inhaler is covered, and the patient should be given the option to get the best price, which might mean using Ventolin HFA, Proventil HFA or ProAir HFA. But if the patient really wants the ProAir RespiClick, then use the above processing information along with an OTHER COVERAGE CODE of 3 or 8. Using a 3 or 8 tells the copay card processing company (in this case, Relay Health) that the patient HAS insurance but the drug is NOT covered. This should process for a copay of $16.37. It is Teva’s way of helping patients where they haven’t yet negotiated for formulary status.
B. MEDICARE PATIENTS (2 situations):
1. ProAir Respiclick COVERED but copay > $15. This one is a bit more tricky. By law, you cannot use the above processing information to lower the copay of a Federally funded program. It won’t work. So if (for example) a patient has Medicare D and their copay for the Respiclick is $50, they would ordinarily be stuck paying that amount. However, there is a way to use the above processing information and bring their copay down to $16.37. What I’m talking about is the use of a prescription discount card as the primary insurance. In this scenario, you could process the prescription as follows:
For Primary insurance (this is a “discount” card):
ID: Use Patient Phone Number (or any 10 digit number)
Secondary insurance information:
Use the above ProAir RespiClick Processing Numbers. Once successfully billed to both cards the copay will be reduced to $16.37.
2. ProAir Respiclick NOT covered. Again, just like with the commercially insured patient, you can use the above processing information with a “3” or “8” in the OTHER COVERAGE CODE field to obtain a $16.37 copay for 1 inhaler.
C. UNINSURED PATIENTS
The ProAir Respiclick processing information above can be used in combination with an OTHER COVERAGE CODE of 1 (meaning they have no other insurance) to reduce the retail price of the ProAir Respiclick by $20. This will reduce their copay down to about $33.37. BUT you could do better for them if you would run a discount card as mentioned in B (1) above followed by the ProAir RespiClick Billing Information. By doing so their copay should come down to $16.37.
The above approaches should work for most pharmacies. However, your individual pharmacy may have policies about the use of either copay cards or discount cards. This article is not suggesting that any one albuterol inhaler product is superior to another, and I am in no way trying to push this product (though I have both friends and family who have used it and like it). The point is the discounting available right now from Teva and how to take advantage of it while it lasts. I believe the current program will expire on 12/31/2016.
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