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

[Mrs Helleck]

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?

[Esme12, ASN, BSN, RN]

I don't know but I am interested to hear what others think

[xoemmylouox, ASN, RN]

I often tell my computer savy patients to look online at the manufacturer's websites. Often they offer discounts and or assistance programs for brand name medications. I also tell them to ask for samples and/or discount cards for every rx at any Md's office. For those who aren't computer savy if they ask for samples or discount cards it can still help. I also offer to print off all of the paperwork from the websites if the patients don't have a computer/aren't computer savy. It takes up some of my day that I really don't have to spare, but I have had patients that have saved tons of money this way.

[mhy12784]

I know my hospital tries to help patients by directing them to medications on the Walmart 4$ generic list.

Although I dont yet know a much about that program.

[iluvgusgus]

Try to go to Johnson and Johnson's website, they have patient assistance programs, see if her injection is listed, they cover a lot of expensive meds and may give her free injections or very discounted.

[applewhitern, BSN, RN]

I was just looking over the National Council on Aging Benefits checkup site. Looks like if she fits the income requirements, she can avoid the donut hole.

[brandy1017, ASN, RN]

Patients can get $4 generics thru Walmart, Target, and Kmart. Just ask for the cash only price and don't go thru medicare or private insurance. They have a list of meds that qualify so the dr can prescribe cheaper, safer, proven generics vs paying thru the roof to be a guinea pig for the pharmaceutical companies! Each store's list is similar, but slightly different.

The medicare donut hole will be phased out in 2020 but till then its thousands out of pocket! I read that some medicare insurance companies will speed you into the donut hole by charging hundreds of dollars on generic meds you could get for $4 cash! The way to avoid this is to pay cash and refuse to let them process it thru your insurance.

But while the $4 generics are wonderful, other generics can cost as much as the name brand esp at Walgreens, walmart. 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.

[twinkerrs]

Also for more expensive meds tell them to call around to locally owned pharmacies that do not have 4 lists. These pharmacies do not have to recoup losses on 4 dollar drugs like the big box places. This is especially true with psychotropic drugs. Example wal mart wanted my patient to pay 350 dollars for a med when she was in the donut hole. We called a locally owned pharm and got it for under 30. Of course this didn't help her get out of the donut hole but it did keep her on her meds.

[Twinmom06, ASN, APN]

had an issue last year with guy who didn't have insurance and the local pharmacies wanted him to pay $$$$$ for Levaquin (even the generic). He only needed it for 5 days. The hospital's outpatient pharmacy (which they touted to us as employees) also would fill scripts before the pt left the hospital - $5!!!!! The local pharmacies (CVS included) should be ashamed of themselves.

[AgentBeast, BSN, RN]

Consult social work. Seriously these folks are a wealth of information regarding medication assistance programs.

[dudette10, MSN, RN]

Consult social work. Seriously these folks are a wealth of information regarding medication assistance programs.

Yes, social work is the specialty that has this information. If, during admission, I find out that the patient has issues with obtaining food, mobility in the home, or paying for prescriptions, I immediately put in a social work consult. I do not know enough to help the patients on my own, but I know that SW can help them.

[calivianya, BSN, RN]

Thanks for starting this thread. I have a prescription for something my insurance doesn't cover, and I just found a discount card available through the manufacturer's website that gets me a discount up to $55/month off my medication. LOL, I know this thread was for helping patients but I forgot about this kind of stuff too.