Navigating Medication Patient Assistance Programs & Tips for Using Copay Cards

To round out my blog series on “Affording Diabetes Medications”, let’s talk about how to navigate the process of medication patient assistance programs and tips on how to use medication copay cards.

Let’s start with a story…Sally, who has had Type 2 diabetes for about 10 years, recently was started on Lantus® insulin. However, she could not afford this medication as she had lost her job and had no insurance nor did she qualify for government assistance. Fortunately, Sally qualified for patient assistance program to receive her Lantus® at low cost.

Now you may be wondering who qualifies for medication assistance program. For most programs, folks who do not have prescription insurance and do not qualify for government assistance (Medicaid or Medicare) may qualify if they make less than federal poverty level (FPL). Honestly, the income cut off level for qualifying depends on the specific assistance program. “Needymeds” website has a nifty FPL income calculator on the web page for the specific programs.

Where do you find the websites that provide a listing of the necessary details, web link to the specific program for medications, and with available patient assistance programs? I have found 3 websites (listed below) that do a great job in providing all of this information:

• NeedyMeds (www.needymeds.com)
• RxAssist (www.rxassist.org)
• American Association of Clinical Endocrinologists (AACE) Prescription Savings Directory (http://prescriptionhelp.aace.com/)

You are probably asking, “What is the application process?” The easiest process to get the application is to simply download the form. Most forms will request patient information and a separate section for the healthcare provider (physician, nurse practitioner, physician assistant) to complete. Regarding patient information, demographic details such as address, phone number, email address must be provided. Your healthcare provider will complete information regarding your medication and medical information.

Most program forms will require the number of people in household and annual household income (calculate by adding income for all persons in household) as well as income verification. Some programs may require proof of income such as copy of tax return.

Helpful tip: Complete your section then drop off the form at your healthcare provider’s office as they can fill out the rest of the form and submit it.

I can hear you asking, “Once the form has been submitted, how long does it take for me to receive the medication?” Great question! Normally, it takes only a few weeks for the process to be complete and medications to be sent. Depending on the program, the medication will be sent either directly to patient or healthcare provider’s office. If the medications are sent to your healthcare provider’s office, normally an office staff member will call you to make necessary arrangements for you to receive the medications.

And yes, there is an annual renewal required? Most programs will require new application and documentation each year so plan ahead!

Let’s finish this blog with information on prescription copay cards. You know those cards that your healthcare provider may give you when starting a new brand name medicine or you find online at pharmaceutical company website that states your copay will be specific amount (i.e. $25)? Great tip…when starting a new brand name diabetes medication, ask for a copay card. A few additional tips to keep in mind with these cards are below:
You typically are not eligible to use if you have state or federal insurance (i.e. Medicaid or Medicare).
Copay amount will vary if you have insurance as compared to paying case without prescription insurance.
Check the card to see if need to activate before going to the pharmacy.
Ask if your pharmacy will accept the copay card. Not all pharmacies accept all copay cards.
Medication may still require prior authorization if it is not preferred on your prescription insurance’s formulary list.

As we wrap up this topic, a story about Sandy, who recently started on Trulicity®, received a copay card to take to the pharmacy to get her copay amount decreased. While at her pharmacy, Sandy learned that her healthcare provider had to submit a prior authorization (PA) for Trulicity® before she could use the copay card. Trulicity® was not preferred on Sandy’s prescription insurance. Unfortunately, the PA took longer than expected so she could not use the copay card for 2-3 weeks to receive the reduced copay. However, her healthcare provider’s office provided her with samples which got her through until she was able to use her copay card.

Coming up! I look forward to sharing my personal story of my two week experience with wearing the Dexcom G5 continuous glucose monitor. I’ll let you know if I recommend it – stay tuned!

Let’s Celebrate American Diabetes Month

Guess what! November is American Diabetes Month!!! Yes, an entire month to celebrate patients with diabetes. The American Diabetes Association is conducting a terrific campaign to focus on Diabetes – a letter writing campaign about what you want to say to Diabetes.  Do you want to share with the world how diabetes makes you feel? To do so, share your letter or video letter on any of your favorite social media using #DearDiabetes.

In honor of American Diabetes Month, I have a diabetes story to share from a diabetes educator viewpoint.  After wrapping up a great diabetes meeting in Chicago, along with a little personal time with my husband, it was time to head back home to Georgia. We caught an Uber ride to O’Hare to catch our late Sunday afternoon flight.  You know those initial awkward moments after hopping into an Uber – the luggage barely fit into the trunk, no leg room in the back seat, and blaring music that I couldn’t even understand the words). I wondered whether I should talk or not with the Uber driver, so I glanced over to see my husband reaction the music to my surprise he was looking straight head anticipating the trip back home and appearing to have tuned out the loud noise our driver called music.

As a true southern gal, I tend to jump into conversations rather easily as I have a true gift of gab.  The usual small talk commenced with my asking the driver about his work and hobbies.  Michael, the Uber driver, asked why I was in Chicago, so I excitedly shared with him about my serving on a board for a national diabetes organization. This opened the door to share my passion for diabetes education and my desire to help those with diabetes.  I had opened Pandora’s box without realizing it.  Looking back through the rearview mirror at me, with great curiosity he asked the question, “what are the signs and symptoms of diabetes?”  Without realizing what was about to happen, I had just opened the door for a very important conversation with this young man! In keeping it simple, I did my usual short summary when I have patients or students ask this question…being really thirsty, urinating a lot, and blurry vision.

Okay, we all know that this is not the complete list, but these are three major symptoms.  Again looking up in his review mirror he asked,”I wonder if I have diabetes?” He went to share. “When I worked at a paint factory, I would get nauseous sometimes and it got really bad a couple of times.  My boss said I had to get checked out to make sure I was okay.”  He said all of the tests came back normal. His story continued..”I do remember that I felt better after I drank some Sprite. Maybe I have diabetes?” I reassured him that he most likely does not have diabetes but rather maybe experiencing hypoglycemia (aka low blood sugar).  I described it as feeling shaky, dizzy, and like you are going to pass out.  He connected with these signs and symptoms. So I asked Michael, “… do you go long periods without eating?” He replied, “Yes, I feel this way when I am working out if it has been too long since I last ate.”  I encouraged him to eat a snack before working out, not to go more than 4 – 6 hours without eating, and make sure to have protein (i.e. cheese, nuts, meat) with each meal and snack.  Michael was grateful for the information I had shared with him.  And as always, I encouraged him to have regular checkups with his general practice physician!

A simple Uber ride to O’Hare provided an opportunity to share with Michael the seriousness of diabetes and low blood sugar- not to mention that the great conversation made the traffic seem not as bad! A great close to a great trip to Chicago!

#DearDiabetes #DiabetesMonth  #reecespiecesinadiabetesworld

 

Website Programs and Discount Cards

In this second of a three part series on affording diabetes medications, an overview of websites, medication discount programs, and prescription discount cards are all highlighted. I have found numerous websites that exist to assist people with an array cost saving options for medications. Below is a short list of some of the most common websites and the key points for each.

o GoodRx (www.goodrx.com)
• Compare drug prices to locate a local pharmacy with lowest cash price for a specific medication (put in drug name, quantity and zip code) for your home area.
• GoodRx coupons will help lower the overall cost of prescriptions. Print coupon and bring with you to your pharmacy.
• However, Coupons will NOT lower your copay if you have insurance.
• If you are a techie an App is available!

o BlinkHealth (www.blinkhealth.com)
• Anyone can use – regardless of insurance status.
• Good ONLY for generic medications.
• Search for medication and pay online at website.
• Name and date of birth on your BlinkHealth account must match your prescription.
• Print out blink card and bring with you to your local pharmacy. Copay will be $0.
• Refundable purchase.
• Mobile App is available.

o NeedyMeds (www.needymeds.com)
• Helps people locate assistance programs to purchase their medications and contain other healthcare costs.
• Works with patient assistance programs of several pharmaceutical distributors.
• Good for prescription medications as well!
• No registration required.

o American Association of Clinical Endocrinologists (AACE) Prescription Savings Directory (http://prescriptionhelp.aace.com/)
• A list of branded endocrine –related medications name drugs that have discount or rebate program.
• Easily accessible in alphabetical order.

o RxAssist (www.rxassist.org)
• Patient Assistance Program Center.
• Offered by CMS.
• A list of brand name drugs that have discount or rebate program.
• Easily accessible, in alphabetical order.

There are numerous prescription discount cards available that provide medication cost savings. Partnership for Prescription Assistance (https://www.pparx.org/prescription_assistance_programs/savings_cards) is a website that provides a lists of prescription savings cards. A sampling of only a few of the many available prescription savings cards is below.
• Better Rx Card (www.betterrxcard.com)
• Georgia Drug Card (www.georgiadrugcard.com)
• Discount Drug Network (www.discountdrugnetwork.com)
• Easy Drug Card (https://easydrugcard.com/)
• App Available
• WebMD Rx Savings Card (https://www.webmd.com/rx)
• App Available
• Drugs.com Discount Card (https://www.drugs.com/discount-card/)

Lastly, some pharmacies offer prescription savings clubs or rewards programs. These clubs or programs are particularly useful if patients get all of their prescriptions filled at the particular pharmacy. Below is a list of a few national programs.
• Walgreens Prescription Savings Club
• Kmart Pharmacy Rewards
• Rite Aid Rx Savings Program

As a diabetes educator, I have assisted numerous patients with getting prescription drug assistance information and forms through needymeds.org as it is easy to use and has all of the available assistance program details in one place. Also, I explain how to complete paperwork and required documentation for each patient. If you are an educator or provider, I highly encourage you to guide patients through this process as it can be very confusing. If you are a patient, reach out to your diabetes educator or provider for assistance navigating this process.

To be savvy in saving money on prescription medications, a little homework before going to the pharmacy is key. Make sure to check the websites listed above and check for available prescription discount cards in your area. Also, investigate savings clubs or rewards program with your local community pharmacies. These tools in your savings toolbox will take the pressure off your wallet. #savingmoney   #NeedyMeds  #BlinkHealth #GoodRx   #RxAssist #PrescriptionHelpAACE #discoundcards

Drug Formularies and Cost Savings Tips

Do you recall a time when you went to pick up your prescription from your pharmacy only to be blown away at a high copay? I can assure you that your local pharmacy and pharmacist are not to blame. Your insurance company determines the copay amounts for medications. So what can you do to prevent being blown away again the future?

Drug Formulary

A drug formulary is a list of medications that are covered by insurance company. The goal of formulary is the efficient and appropriate use of medications. Commonly, medication formularies are tiered (categories of medications) with less expensive preferred drugs as level one and more expensive branded drugs being non-preferred. The copay will be the least amount for tier one (preferred medications) and most for non-preferred drugs. There are also often quantity limitations.

Knowing what medications are listed on your drug formulary is key BEFORE going to your physician, provider or pharmacy. Additionally, the name of your formulary is key as this allows you to access it online. There are a few various ways to find your formulary. Below are a couple of resources for obtaining your formulary.

  • Check your employer’s website or human resources department
  • Insurance card (phone number for Pharmacy Benefits Manager)

When reading your formulary, you will see the following items.

  • Tiers: several various categories with at minimum tier one (or preferred) and non-preferred
  • Drug classes under each tier
  • Individual drugs listed under each drug class

It is important to remember that drug formularies are updated yearly so make sure to stay to up to date. Lastly, copays for each tier and yearly deductibles are vital information for budgeting and planning ahead for medical related expenses.

Cost Saving Tips

  • Generics: These medications cost significantly less than brand name drugs. I highly recommend using generic over brand when possible. Below are some examples.
    • Metformin (generic): Glucophage ® (brand)
    • Pioglitazone (generic): Actos® (brand)
    • Glimepiride (generic): Amaryl® (brand)
  • Free diabetes medications: Publix offers metformin at no cost to the patient.

90 day supply: Check to see if copay is less for 90 day versus 30 day supply. Also, find out if you can get the 90 day supply from your local pharmacy.

Please share your thoughts and comments

#diabetes #medications #pharmacy #cost savings #living with diabetes