Many caregivers know that prescription medications are a double-edged sword. In many cases, they are necessary to improve, or sustain, life – or quality of life. But prescriptions are expensive. And when you’re on a multitude of medications, it adds up.
I’m not talking about the $4 generic antibiotics you pick up at the drug store and refill only once. I’m talking about medications that are taken daily over the course of months or years. I’m talking about biologic medications that require a specialty pharmacy to deliver in refrigerated containers. I’m talking about medications that must be delivered via infusion therapy.
Insurance coverage varies greatly in the Untied States. You may have coverage that includes all prescription medication with a $2 copay per refill – or you may have coverage that has a tiered copay structure or even requires contributions to a deductible.
And since we often face challenges, sometimes it’s just easier to hand over your credit card and accept that this drug is “x” amount. Here are some things that I’ve learned in dealing with prescriptions that help my darling manage symptoms and control progression.
- Sometimes, the cash price of a medication is cheaper than your insurance copay price. Yes. You read that correctly. If your prescription coverage dictates that a “Tier 1” drug – regardless of medication – is $10 per prescription, it is possible that some of the drugs that fall into that category would be cheaper if you paid in cash without running the insurance. Ask your pharmacist for the cash price and the prescription price to comparison shop!
- Ask for the generic version, or if there is a therapeutic alternative. Depending on where you live, your pharmacist may not offer the generic version of the drug that was prescribed. I personally always ask if a generic version exists – the cost is always less for the generic. Some people may react differently to the generic version – but you won’t know unless you try. I think it’s worth it to fill the prescription one time to see if the generic works. Sometimes, a generic doesn’t exist for the drug that is prescribed – but there may be other similar drugs that treat the same symptom/condition under a different name. Ask your pharmacist if there is a therapeutic alternative that is cheaper. The best example that I know of is that there are many drugs that treat incontinence (a singular symptom) – some of those drugs have generics, others do not. As if a therapeutic alternative that is less costly could work, and ask what you need to do to try that drug out first.
- Copay & Medication Assistance Programs exist for many biologics. Does the “expensive” medication your darling take cost more than $50/month? Is it a brand name drug? Many pharmaceutical companies offer copay assistance programs to people who have insurance coverage but must pay a lot out of pocket to access the medication. For those who are uninsured, the pharmaceutical companies may offer medication assistance. Look up the medication and figure out the name of the pharmaceutical company – then do some googling with the name of the pharmaceutical company and “copay assistance” or “medication assistance” in the search. In both cases, the pharmaceutical company will need to connect with the prescribing physician to get them to fill out some paperwork. There may be additional paperwork that you (or your loved one) need to fill out in order to get the medication at a reasonable cost per month. Many times, though, this means that you have to get the prescription filled through a specialty pharmacy, and they may need to assess your need every year in order to keep you on the assistance program list. In my opinion – it’s totally worth the hassle.
- Copay Assistance for Infusion Therapy. The more complicated the administration of a drug, the costlier it is to the patient – so you can imagine that infusion therapy is going to cost more than most other kinds of medications. When an infusion therapy center receives the prescription from your loved one’s doctor, you may receive a call from them to set the appointment up. Ask them to verify benefits AND request copay assistance. Depending on your coverage, you may qualify for copay assistance even for a drug that could cost you thousands of dollars out of pocket.
Drugs are expensive and there is no shame in accessing programs that are there to help keep drugs in an affordable range. You may find some helpful information on Rx Assist: Patient Assistance Program Center, which has a long list of patient assistance program. If the pharmaceutical company for the drug your loved one uses is not listed, do not fret! Look the company name up on Google, eg. Biogen Patient Assistance Program or Biogen Copay Assistance Program.
Has your pharmacist recommended switching your darling to a generic medication? Here’s What to Ask Before Switching to a Generic Drug.