Hi all! There was a post in /r/PersonalFinance about getting patient assistance for an expensive medicine. This is what I work on 60% of my workday now, so I want to share some advice on getting your prescription medications for less money. They are legal, and I'm not affiliated with any medication companies. I'm just a nurse in a multi-specialty clinic who really loves getting people healthier for cheaper.
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Google "[medication] patient assistance program" and "[medication] savings card." THESE ONLY WORK WITH COMMERCIAL INSURANCE, so if you are on medicare or medicaid, save your time and use the tips after this one. The savings cards are typically good for 1-3 medication fills, but can be good for up to one year. They do this because the money they make from your insurance company is adequate to meet their financial needs, and the longer they can keep you on a medication, the more money they make. Patient assistance programs are different in that they typically last 1-2 years. There is typically a simple form that needs filled out with basic information. My best guess is that this is done out of some charity fund that the pharmaceutical companies have for tax purposes or something.
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Check your insurance formulary! Insurance formularies are something a lot of people aren't familiar with. A formulary is basically a list of medications that a pharmaceutical company and and insurance company have agreed will be covered for cheaper. I see this effect patients a TON in insulins, inhalers, and other diabetic medications. I'll use a couple of insulins as an example. Lilly manufactures Humalog insulin, while Novo Nordisk manufactures Novolog insulin. Now, Novolog and Humalog serve the same function in the body, they're just different brand names. So if your insurance has a deal with Lilly, which manufactures Humalog, but you are prescribed Novolog, you may have to pay several hundred dollars that you don't actually need to spend; you just need to call your physician's office and ask them to change your insulin to the one that is on your insurance formulary.
That's just an example (although a real one); it works this way with every insurance and every pharmaceutical manufacturer. You can google "[insurance name] formulary [state] 2019" to find your insurance's formulary. You may be on a Tier 2 (more expensive) medication when a Tier 1 ($0 copay, most of the time) is the same medicine. Your doctor can change your prescription with a phone call most of the time.
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Call your doctor's office. This one might be the most important. If you're overwhelmed with the advice in number 2, just call your doctor's office. Tell them that your medicine is costing you $_____ per month and you can't afford it. Someone in their office can check your insurance formulary and for other things that may make your medications less expensive. Based on my experiences with physicians, it almost never occurs to them to check insurance formularies before prescribing your medications.
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Ask for samples. Your doctor's office may have samples they can offer you. I assume that pharmaceutical companies provide these to offices because they are hoping we will give them to people with insurance to use while we do the pre-authorization dance with your insurance behind the scenes. I work in a metro area with a significant poor population, and we give them out to people who don't have insurance, don't have drug coverage, or ran out of their medications whenever we can. Not every doctor's office has samples (there is talk about how ethical it is to allow pharmaceutical company reps into physician offices), so find out if yours does.
This is pre-coffee so there may be typos or bad phrasing, but when I saw the /r/personalfinance thread, which is locked, I hurried out of bed because I think it's a really important issue, and a place lots of people don't know what the resources are that can help them.
Please feel free to ask questions and I'll answer to the best of my ability. I hope this helps someone!
February 03, 2019 at 08:56AM
