What to Do If You Can’t Afford Your Meds

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Times are hard and people are struggling. I have written many times on this blog about the importance of medications. They are life saving, but they must be taken faithfully and exactly as prescribed if they are to do any good.

But what if you can’t afford your medications? You do have options and almost every drug company has programs that can help. Let’s first look at who is in control of your medication coverage (hint – it’s not your prescriber).

Health Care Then and Now

Maybe you remember simpler times in medicine when your doctor was in charge of everything and you didn’t have to think about your health or health care. Marcus Welby was on TV and (if you were lucky) you had a doctor just like him.

Those days are (long) gone and they aren’t coming back. Nowadays most doctors are specialists. Those that remain in primary care are harried, overworked and underpaid. You can expect to spend about 7 minutes with your doctor – 15 minutes if you are lucky. In today’s world you are just as likely to see a Nurse Practitioner. If so, that appointment will likely last longer than a doctor’s appointment –15 to 30 minutes. That’s because NPs want to enlist you as a partner in your care and teaching you to be a good partner takes more time.

You may wish for the (good) old days when you didn’t have to get involved with your own health care. But like it or not you are now in charge. Maverick Health was founded to help you be a better steward of your own health care.

The Current Medication Debacle

Your prescriber, whether it is a doctor, physician assistant or nurse practitioner, is NOT in charge of what medications you will get – your insurance company is. It’s not the way it should be, but it’s the way it is.

This is how it works. Every individual policy holder (IF you are lucky enough to have health insurance) has a drug “formulary”. This is a list of drugs – some lower cost and some higher cost – that a particular policy or plan covers. For higher cost drugs many insurance companies now require that you “fail” a lower cost generic drug before they will pay for higher cost brand drugs. Some drugs they won’t pay for at all, so if you want those drugs you will have to pay cash out of your pocket.

Your prescriber does not know your particular formulary or drug preferences. Let me repeat that. Your prescriber does not know your particular formulary or drug preferences. Just as your prescriber can’t know you what you like to watch on TV, your prescriber also can’t know if you want to pay extra for a brand name drug or stick only to generics to save money. (Your insurance company wants you only on generic drugs but not all drugs come in a generic form.) You must communicate your preferences to your provider.

Understanding “Preauthorization”

One of the most burdensome tasks that’s fallen to primary care providers (and which is getting worse with each passing day) is “preauthorization” of medications. This is what happens – your prescriber starts you on a medication, maybe giving you samples to see if the drug works before you purchase it. You try the samples, you feel well on the drug, it achieves its desired effect and a prescription is written that you submit to your insurance company. If it is not a generic medication (which it won’t be because generic medications are not sampled to medical offices), the insurance company may require you to fail a generic first or demand that the prescribed drug to be “preauthorized”.

“Preauthorization” basically involves a lot of time and paperwork in which your prescriber’s decision to use this particular drug must be defended to your insurance company. And as I said, your prescriber NOT in charge of what medication you will get – your insurance company is. Finally, even IF it is approved after all this extra paperwork and time is wasted (and which costs your prescriber a lot of money in staff wages and lost time), you will STILL have to pay more for it. Many medical offices are now refusing to do preauthorizations because they are unable to recover the cost of the staff’s time it takes to do them.

What You Need to Do

Like it or not, it is essential that you partner with your prescriber to develop a medication regimen that is both affordable and effective. Your prescriber must know which meds you are willing to pay more for to get the brand and when you need to be prescribed generics.

There is always more than one way up a mountain, but do not expect or assume your health care provider will know your particular formulary or coverage. They won’t. You can no longer just leave the prescribing up the the prescriber. You must be an active participant in your own care and you – not your prescriber – must communicate directly with your insurance company about your medication coverage options.

What to Do If You Can’t Afford Your Meds

Almost every pharmaceutical company has patient assistance programs to help people who can’t afford their brand name drugs obtain them. (Remember, there is no patient assistance for generic drugs through the pharmaceutical industry.) Every person’s circumstances will be different.

With Walmart and other big name stores offering $12 deals for 3 month supplies of certain generic drugs, that may be the way to go for some of your medications. If you are on others that have no generic equivalents, patient assistance through a pharmaceutical company may be the way to go.

Three Tips when Seeking Assistance

  1. Maintain a partnership with your prescriber to make sure you are being prescribed drugs that are both the most effective and most cost effective.
  2. Plan to do all the leg work yourself. Remember you are shopping for yourself. Your prescriber is far to busy to do much more than sign forms that you have already completed as best you can.
  3. Don’t forget that you are going to this trouble because these medications are keeping you well and preventing future disease. Take them faithfully and as prescribed. And don’t give up the fight just because there’s some hassle involved. Your life is at stake.

Since you are reading this online you obviously have access to a computer. Here are some links to patient assistance programs. If these are not helpful, I would Google the name of the specific drug company you need assistance from and call them directly. They can put you in touch with their own patient assistance department.

Good luck. Be tenacious!

Patient Assistance Links

Partnership for Prescription Assistance

RxAssist

NeedyMeds

This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional.

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1 comment so far. Add yours below.

#1 | On April 18, 2010, david halfe said:

very intresting article.


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