Phillip went in for his semi-annual checkup for Crohn’s disease, which he’s lived with for years. Using a combination of diet strategies along with the drug prednisone, flare-ups have been under control. Phil’s doctor suggested he consider switching to a new drug called Humira®. The doctor explained that while Phil hasn’t had any problems with prednisone, this new drug has responded well with some of his other patients and could improve his condition long-term.
Louise, his spouse, went home and called the HR department, which explained that in some cases, specialty drugs can be billed through the pharmacy plan. In other cases, the medication is billed through the medical plan. The HR department wasn’t sure which benefit design the drug would fall under so it referred Louise to her medical plan.
