How do we educate the public on ways to afford medications?

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I recently had a personal experience with my 76 year old mother that opened my eyes to a problem that many be experiencing. The medicare prescription plan has a "donut hole" which as I understand is when the enrollee reaches the first dollar limit on prescription coverage, they then pay out of pocket until they reach another set amount after which they have some additional coverage. What an easy to understand plan for the elder population. My mother is on an injection drug for osteoporosis which she receives twice a year. She was concerned because each injection was $2400 at her PCP's office and that along with her other medications would exceed her coverage placing her in the "donut hole" early in the year. Her insurance agent did some checking and told her the medication cost at the pharmacy would be just under $900 so if her PCP would write a prescription for the medication, my mother pick it up and carry to the PCP's office and have them administer, she would save $1500 for each treatment. The PCP was agreeable to this. My question is how many situations like this occur everyday causing patients to choose between medication and other neccessities? How can we as patient advocates get this information and deliver it to our patients?

Specializes in ICU.

I have insurance thru my employer, but I had all my prescriptions changed to the $4 Walmart ones, to save money on co-pays. Well, guess what. Last week I went to pick up refills of the same meds I have taken for years, and the bill was $97.00, instead of the usual twenty bucks. They had removed/changed the $4 list, but had not notified me via email, snail mail, or phone call. The clerk said they change the list occasionally. Kinda ticked me off; I had the money, but what if I didn't? I could have had my doctor switch the meds, as they are common with multiple ones that can be used.

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Specializes in RN, BSN, CHDN.
For the past several yrs when my mother hits the donut hole, we then use a Canadian pharmacy. Purchase price is half the cost (sometimes better) than if she had to pay out-of-pocket locally. She usually hits her limit towards the end of the yr anyway & wouldn't reach "the other side of the donut hole" for coverage to resume. We also shop around locally; the cost of Lovenox varies quite a bit.

How do you use a Canadian pharmacy? On line or do you have to go there??

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How do you use a Canadian pharmacy? On line or do you have to go there??

They probably do this online but I would use that as last resort. My dad found out that some cheaper med options for my mom that he researched online led to shady non reputable pharmaceutical companies. Do lots of research before buying any meds from other countries online or face to face. Thank god my moms doctor gives her samples when she can and the manufacturer enrolled her in a savings program. I just can't wait for the day the generic version comes out. A pharmacist told us there should be a generic version out in a year.

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Something to remember with the rx discount cards--government policies don't accept them. Medicare, Medicaid, and Tricare will not let their pts use insurance and those copay assistance cards. Let the PCP (or specialists) office know and see if they can call and get a prior authorization on it. PA usually requires more detailed info about why that med is needed; usually there's a step program (pt must try and fail drug x, drug y, and drug z) before they'll cover the rx, some will cover it if pt has the right dx and can't tolerate the other meds. Check the pharmaceutical websites because they may have programs for their particular meds; Prescription Assistance Program | is one for many scripts.

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I use a website (also has an app) called goodRx. It compares the price at any local pharmacy. I haven't gotten into the full ability to know if it can compare across class, i.e. accupril vs. lisinopril, etc. My only complaint is that it frequently gives a price with a "coupon" you need to print out. However, the coupons are not valid with anything that is considered a controlled substance like diet pills or ADHD meds.

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Specializes in SICU, trauma, neuro.
The best overall value for meds is thru Costco. They have a policy of only a small markup and provide great value to their customers. In fact I believe you don't even have to be a member of Costco to access prescriptions. Better yet they have mail order service.

This is correct.

Whenever I go to the pharmacy I've asked what the cash price is. Lots of times it has been cheaper to pay cash than going through insurance--which IS cash anyway, until we reach our deductible.

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Specializes in Leadership, Psych, HomeCare, Amb. Care.

This is why some of the provisions in the ACA aka"Obama Care" don't get the coverage they deserve.

Seniors shouldn't have to search for tips and tricks or handouts to get the medical care they need. The fact that a few companies will offer discounted meds if you know how to work the system just means they are hoping as many people as possible don't work the system and they can make thier fortune. If anyone points out the ethics of charging $8000. for a drug that sells in Europe for $20. they can point out that they "give it away free for anyone who needs it but can't afford it"(by thier standards) If you know what hoops to jump through. Helping patients with the tips and tricks is unfortunately part of my job but it would be much nicer if the system was designed to be fair and affordable for everyone and I could spend my time doing better patient care.

unfortunately, this is an issue that existed decades before anyone ever heard of Mr Obama.

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Specializes in NICU, PICU, Transport, L&D, Hospice.

This thread is an example of the exceptional health care we enjoy here in the USA.

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Specializes in Critical Care.
I have insurance thru my employer, but I had all my prescriptions changed to the $4 Walmart ones, to save money on co-pays. Well, guess what. Last week I went to pick up refills of the same meds I have taken for years, and the bill was $97.00, instead of the usual twenty bucks. They had removed/changed the $4 list, but had not notified me via email, snail mail, or phone call. The clerk said they change the list occasionally. Kinda ticked me off; I had the money, but what if I didn't? I could have had my doctor switch the meds, as they are common with multiple ones that can be used.

Had the same thing happen to me, at first they deleted verapamil from the $4 list and later added it but not for XL so my $4 verapamil now costs over $30. They change the list every year so you have to stay on top of that. I need it for migraines and HTN so I'm stuck paying extra. It really helps with migraines if you can't take a beta blocker ie have asthma.

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Specializes in PACU, pre/postoperative, ortho.
How do you use a Canadian pharmacy? On line or do you have to go there??

Not sure how my parents found this company initially as they never had internet, but we (or doctor's office) fax the prescription directly to the pharmacy there & they mail a 3 month supply; no different than if I use my employer's mail in system. I think Mom started using them in about 2004-2005 & has never had a problem.

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