Financial Health Spotlight: Managing the Costs of Thyroid Eye Disease Treatment

Your treatment for thyroid eye disease depends on your specific symptoms and medical history.

Potential treatments for mild thyroid eye disease include:

• lubricating eye drops, gels, or ointments
• botulinum toxin type A (Botox) injections to your eyelids
• selenium supplements
• lifestyle changes

Treatments for moderate to severe thyroid eye disease include systemic medications, such as:

• glucocorticoids, like:
  • oral prednisone
  • intravenous methylprednisolone
• immunomodulating drugs, like:
  • methotrexate
  • azathioprine (Imuran)
  • mycophenolate mofetil (CellCept)
• biologic drugs, like:
  • teprotumumab (Tepezza)
  • rituximab (Rituxan)
  • tocilizumab (Actemra)
  • adalimumab (Humira)
  • infliximab (Remicade)

In some cases, your doctor may also prescribe:

• orbital radiotherapy, which uses low dose radiation to reduce inflammation in your eyes
• surgery to repair damage to your optic nerve, your eyelids, or other tissues
• corrective lenses, such as prescription eyeglasses

Talk with your doctor to learn about your condition and treatment options. Your treatment needs may change over time, as the inflammation and symptoms become more or less severe.

The costs of managing thyroid eye disease depend on several factors, including:

• your treatment plan
• where you receive treatment
• the specific type, brand, and dosage of treatment received
• whether you have health insurance that covers your treatment
• whether you qualify for any rebates, discounts, or patient assistance programs

Certain treatments are more expensive than others. Treatment for moderate to severe thyroid eye disease tends to cost more than treatment for mild thyroid eye disease.

A 2022 research abstract evaluated the cost of certain treatments for moderate to severe thyroid eye disease in the United States and found the following average costs:

A 2021 research abstract found the average cost of each surgical encounter for thyroid eye disease in the United States was $21,875 USD.

You may also need to receive certain tests to diagnose or monitor thyroid eye disease or check for treatment side effects. There are costs associated with these tests, as well.

The cost of a specific treatment or test may vary from one region or healthcare center to another and may change over time. Talk with your doctor, pharmacist, or healthcare center to learn how much a treatment or test may cost. If you have health insurance, contact your insurance provider to learn whether your plan will cover any of the cost.

Different health insurance plans cover different tests and treatments for thyroid eye disease.

Read on to find strategies for optimizing your insurance coverage.

Learn what your plan covers

If you have health insurance or you’re shopping for a new plan, take some time to learn about:

• the out-of-pocket costs associated with the plan, including monthly insurance premiums, annual deductibles, and copay or coinsurance fees
• the covered benefits, including tests and treatments that the plan covers
• the drug formulary, which lists the specific medications covered
• which healthcare professionals are in the plan’s network

You can find this information on your health insurance provider’s website or in documents provided by your insurance provider. You may also contact your insurance provider directly to ask about your out-of-pocket costs, covered benefits, or other information.

You might find that certain formulations or brands of medications are covered under your drug formulary, but others are not. Consider bringing a copy of your formulary to your healthcare appointments, so your doctor can see which specific medications are covered for you.

Follow the steps to get reimbursement

Even when a specific healthcare service or product is covered by your insurance plan, you may need to meet certain criteria or follow certain steps to get reimbursement.

For example, you might need to:

• Meet your annual deductible first.
• Get care from a doctor in your network.
• Get a referral or prescription from your doctor.
• Work with your doctor or their staff to submit a prior authorization request to receive pre-approval from your insurance provider for a specific test or treatment.

If your insurance formulary doesn’t include any medications that meet your treatment needs, your doctor may request a formulary exception.

Sometimes you might need to try one treatment before your insurance provider will consider covering another treatment. This is known as step therapy.

If your insurance provider denies a claim for coverage, you may file an appeal.

Shop around

You might find that changing insurance plans helps improve your coverage or lower your costs.

Before you change plans, learn whether:

• your current healthcare professionals are within the new plan’s network
• your current treatments are covered by the new plan’s benefits
• your current medications are included in the new plan’s formulary

If you change plans, you might need to change healthcare professionals or treatments — or else pay more to continue with your current healthcare professionals and treatments.

If you don’t have health insurance, consider researching your insurance options.

You might qualify for government-sponsored insurance, such as Medicaid or Medicare.

Read on to find other strategies that may help lower the costs of managing thyroid eye disease.

Ask about manufacturer discounts

Some drug manufacturers offer discount cards or coupons to lower the cost of the medication they sell. You may need to have certain types of health insurance or meet other criteria to qualify.

You can visit the manufacturer’s website for any medication that you’re taking to check for discount cards, coupons, or other manufacturer-sponsored assistance programs.

You may also ask your doctor, pharmacist, or other healthcare professional whether they know about any manufacturer-sponsored assistance programs.

Sometimes, your doctor may also have free medication samples from the manufacturer, which they may be able to share with you.

Explore other patient assistance programs

Some government, professional, and patient organizations run financial assistance programs for people with thyroid eye disease who meet certain eligibility criteria.

Some of these programs may help cover the costs of healthcare. For example, the American Academy of Ophthalmology (AAO)’s EyeCare America Program provides free eye exams for eligible older adults.

Other programs may help cover the costs of non-medical expenses. For instance, the National Organization for Rare Disorders (NORD)’s Thyroid Eye Disease (TED) Emergency Relief Program offers short-term financial assistance for unexpected or emergency non-medical expenses.

To learn about other financial assistance programs:

• talk with your doctor
• visit the AAO’s resource page
• review the Prevent Blindness Vision Care Financial Assistance Directory

You will need to meet certain eligibility criteria for any financial assistance program.

Contact the organization that runs a specific program to learn whether you qualify.

Discuss potential changes to your treatment

Let your doctor know if you’re finding it hard to manage the costs of thyroid eye disease.

Consider asking them whether less expensive treatment options are available.

For example, they might be able to

• prescribe a less expensive generic medication, instead of a brand-name medication
• prescribe a medication that’s covered under your health insurance formulary, instead of a medication that isn’t covered
• recommend another less expensive treatment

They can help you understand the potential benefits and risks of changing treatments.

If your health insurance provider has denied coverage for a specific treatment, your doctor or a member of their staff might be able to help you file an appeal.

Read on to find several strategies for managing medical bills.

Review your records

Review each bill or receipt that you receive from a healthcare professional to make sure the charges reflect the care you actually got.

You should also review each explanation of benefit (EOB) that you get from your health insurance provider to learn whether they have approved or denied a reimbursement claim.

The EOB will also tell you how much your insurance provider will cover for each healthcare product or service, as well as the amount that you owe.

Make sure the bill or receipt from a healthcare professional aligns with your EOB. Contact your healthcare professional or insurance provider to discuss any questions or concerns.

Negotiate a discount or payment plan

If you can’t pay a bill right away, consider asking your healthcare professional or healthcare center for a reduced cost of care or an interest-free payment plan.

Making regular payments may stop the bill from going to collections, which may help protect your credit score.

Enlist help from an advocate

Consider asking your doctor or healthcare center whether they have any patient advocates or medical billing advocates on staff who can help you:

• access and understand your medical records and bills
• file requests, claims, or appeals with your insurance provider
• negotiate a discount or payment plan with your healthcare center
• connect you with financial or social support resources

You may also search for an advocate online or contact the Patient Advocate Foundation, which is a nonprofit organization that provides patient advocacy services and resources.

Consider applying for a loan

If necessary, you may be able to take out a personal loan to help cover healthcare costs.

Some financial institutions offer a specific type of personal loan known as a medical loan. If your credit score is high enough, you might be able to take out an unsecured medical loan without putting property up as collateral.

Make sure you know what the interest rate and monthly payments will be before you take a loan. Carefully consider whether or not you can afford the payments and whether there are changes you can make to your budget or spending habits to cover the payments.

Your doctor may prescribe a combination of lubricating eye drops, medication, and other treatment for thyroid eye disease. Treatment may be expensive, especially for moderate to severe thyroid eye disease that requires systemic medication or surgery to manage.

Health insurance can help cover some of the costs of managing thyroid eye disease. Consider taking time to compare insurance plans and learn what your plan covers. Follow all the necessary steps to get reimbursement for covered benefits.

You may also explore other strategies and resources for lowering the cost of care. For example, check for financial assistance programs from drug manufacturers and government, professional, or patient organizations.

Let your doctor know if you’re still finding it difficult to cover the costs of care. They may recommend changes to your treatment plan to help lower the costs.

Reviewing each healthcare bill, receipt, and insurance record may help you find and correct costly errors. If you can’t pay a bill, you may request a discount or payment plan from your healthcare professional or center. Applying for a medical loan is another option.

You might find it helpful to hire a patient advocate or medical billing advocate to help you manage your records, pay your bills, and access financial support resources.