You’re juggling doctor’s appointments, work and enjoying life with friends and family. Whether you have diabetes, heart disease or cancer, the cost of Rx medication can add up and stand in the way of your treatment and your peace of mind — even if you’re insured.
Rx Assistance: How to Deal When You Can’t Afford Your Medication
So what are your options? Good news: From patient assistance programs to support groups that offer financial support, you have ways to save.
Start with Your Doctor
Understand why you’re being prescribed a medication and whether generics or other substitutes would be safe. If your insurance claim has been denied or your co-pay is unaffordable, ask your doctor and their staff for recommendations. Erin Singleton, Chief of Mission Delivery at Patient Advocate Foundation, emphasizes that doctors don’t know what your insurance covers — it’s up to you to tell them the cost of your medicine is causing a strain.
“Most providers have someone who can help,” says Singleton.
Understand Your Insurance Plan
If you’re selecting new insurance, be sure to consider premiums, deductibles and co-pays when adding up a plan’s cost. If your current insurance isn’t working for you, consider switching to a new plan if it’s an option.
Review the list of prescription drugs your plan covers – called the formulary. If your doctor prescribes medication not on your formulary, they might be able to make a substitution.
If you’re sticking with the same insurance, don’t forget to regularly check the formulary, as it can change.
Connect with Groups that Explain your Choices
Many groups offer advice and even direct financial support. Disease-specific support groups, such as the American Diabetes Association, and patient-advocate groups, such as the Patient Advocate Foundation, can be good places to start. The Patient Advocate Foundation helps you understand your coverage, works with your insurer and doctor and also provides direct financial assistance.
After taking these first steps, you can focus on finding discount programs. There are multiple choices, each with pros and cons. NeedyMeds offers webinars that summarize your options. When using the following programs, it’s important to read the fine print and make sure your savings will be more than any fees charged. Check back for new drugs and lower prices to be added to these programs, as the lists and prices change often. Some programs collect and share personal data; it’s a personal decision whether savings are worth the tradeoff.
Patient Assistance Programs (PAPs): These cover all or most of the cost of brand-name drugs for limited time periods. Eligibility varies by program. They’re usually available to uninsured or underinsured consumers with relatively low incomes. Sites such as NeedyMeds, RxAssist and Partnership for Prescription Assistance can help you sort through PAP options.
Singleton recommends applying even if you don’t fit the eligibility requirement. NeedyMeds staff agree, advising you ask for economic hardship exceptions, which are common. And if the drug you need is not included in a PAP, call the drug company directly and ask for assistance. It’s not uncommon for companies to come through. While there are services that will complete PAP applications for a fee, Singleton believes they’re not usually necessary.
Don Downing, Clinical Professor at the University of Washington School of Pharmacy, also reminds consumers that PAP benefits don’t last forever; if your doctor can prescribe an equally effective drug that doesn’t require you to use a PAP, that might be a better solution.
Shopping Around and $4 Generics: Be sure to compare prices at all pharmacies and discount stores available to you, including mail order and independent pharmacies. Don’t default to your nearest Walgreens or CVS; comparing with Costco, Walmart, Target and Sam’s Club is a good start. Personally ask your pharmacist for the lowest price available – don’t rely on prices you find online or the initial price your pharmacist quotes. In addition, asking for 90-day prescriptions can help you save.
You may also want to ask your doctor about generics. For many, generics are a first line of attack for cost savings. Many large retailers (such as Target and Walmart) offer what are called “$4 Generics.” Costs may actually range from $4 to $15 for a 30-day or 90-day supply; some but not all programs may require membership and charge a fee. (Note: your doctor may have medical reasons for not prescribing a certain medication to you.)
Discount Drug Cards: Some of these cards, such as NeedyMeds and RxAssist are free, while others have fees. Make sure savings at your pharmacy with these cards will be larger than total costs. Downing points out that actual savings can be less than advertised, so check with your pharmacy. You can search for additional cards online and learn how to choose them.
Coupons, Rebates and Free Samples: These are also offered by drug companies. Coupon and rebate information can be found at NeedyMeds and RxAssist. These programs offer savings on brand-name drugs, but they may still wind up being more expensive than generics.
Prescription costs can be overwhelming, but there are savings options out there when it comes to your Rx — and people ready to help you sort through them.