David Baxter PhD
Late Founder
Programs offer free, cheaper prescription meds
MSNBC
Tues., April 7, 2009
1 in 5 in U.S. skips drugs or split pills to save money, but help is available
TRENTON, N.J. (Associated Press) - Jaimy Gerler was frantic this past winter when the doctor prescribed yet another costly medicine for her toddler daughter, whose allergies had landed her in the hospital the winter before.
With her salesman husband's income selling tools for auto mechanics down and $10,000 in hospital bills still unpaid from her daughter Taegan's premature birth, the Perryville, Mo., woman thought, "$200 a month — how can we afford it?"
Gerler, who runs a day care in her home, is among the growing number of people seeking prescription medicines cheap or for free. The rising demand is a result of millions losing jobs and health insurance as the recession worsens, even as health care costs continue to rise 5 percent per year.
One recent survey found 1 in 5 Americans have gone without their medications, split pills or skipped doses — risking their health or even their lives.
That doesn't have to be. Hundreds of programs, some little known, offer medicines free or at a discount.
Virtually all assistance programs have income limitations and other rules, and require jumping through quite a few hoops, but several have eased eligibility requirements because of the recession, even though they've seen a surge in applicants.
Getting started
The first step should be to tell your doctor you need help. He or she often can give you free samples provided by drug companies, although some doctors say that they're getting fewer samples now, just when they have more patients asking for them.
A good next step is to do an Internet search for "patient assistance programs," or go to one of several Web sites sponsored by hospitals, consumer groups, drugmakers and others, that connect patients with individual assistance programs.
Those portals include
Some have links to coupons for rebates or free samples, or to programs such as Together Rx Access. It supplies cards that people who don't have drug coverage and aren't eligible for Medicare can use in nearly all pharmacies to get discounts of 25-40 percent on prescriptions.
Readying your applications
Before applying, assemble the documents you likely will need to get approval for a patient assistance program:
Don’t be shy
Patients who have been through the process say not to accept rejection as final. Sometimes writing a letter detailing why a medication is so important, or applying to additional programs, brings success.
Once you've gotten approval, though, you'll almost definitely have to reapply every year. That can cause a gap without the medicine, so don't wait until the last minute.
Besides helping get medications free from a manufacturer or charity, assistance programs often help patients get qualified for Medicaid, which covers poor and disabled people, or other government health programs.
The Patient Advocate Foundation will appeal denials to try to reverse them, help people get Social Security disability income or Medicaid coverage, and get preauthorization for expensive medical care. It does so using case managers trained in the ins and outs of specific issues.
"For people that need case management to get resolution, 98 percent get what they need" or close to it, said the foundation's chief executive, Nancy Davenport-Ennis.
Even people with health insurance can sometimes find help, such as when they need medicines for cancer or other complex illnesses that can cost tens of thousands of dollars a year, or when they have special circumstances.
Gerler, the Missouri day care operator, and her husband pay $750 a month for individual health insurance for the family of five. However, the plan, which they bought 1 1/2 years after Taegan was born, excludes coverage for pre-existing respiratory and ear problems for Taegan, 5.
Gerler managed on her own to get approval for Singulair, an asthma and allergy drug that had cost her $90 a month, free from manufacturer Merck & Co. She got free samples of some other allergy pills, and a ProAir albuterol inhaler from doctors. But when Taegan's pediatrician last fall also prescribed an Advair inhaler, costing $200 a month, she got nowhere, despite appeals to about 20 people at the manufacturer and various patient advocacy groups.
"Everyone said, 'If you have insurance, we can't help you,'" she recalled.
Finally, she found a Patient Advocate Foundation caseworker who "knew what to say to get what she wanted." Gerler had to provide the insurance policy rider showing what care was excluded, and even go through applying for and being rejected by Medicaid. Still, the foundation got drugmaker GlaxoSmithKline PLC to provide Advair inhalers free within a month.
"I was jumping up and down when I found out," Gerler said last week. "She's been healthy all winter long. I just couldn't ask for more than that."
MSNBC
Tues., April 7, 2009
1 in 5 in U.S. skips drugs or split pills to save money, but help is available
TRENTON, N.J. (Associated Press) - Jaimy Gerler was frantic this past winter when the doctor prescribed yet another costly medicine for her toddler daughter, whose allergies had landed her in the hospital the winter before.
With her salesman husband's income selling tools for auto mechanics down and $10,000 in hospital bills still unpaid from her daughter Taegan's premature birth, the Perryville, Mo., woman thought, "$200 a month — how can we afford it?"
Gerler, who runs a day care in her home, is among the growing number of people seeking prescription medicines cheap or for free. The rising demand is a result of millions losing jobs and health insurance as the recession worsens, even as health care costs continue to rise 5 percent per year.
One recent survey found 1 in 5 Americans have gone without their medications, split pills or skipped doses — risking their health or even their lives.
That doesn't have to be. Hundreds of programs, some little known, offer medicines free or at a discount.
Virtually all assistance programs have income limitations and other rules, and require jumping through quite a few hoops, but several have eased eligibility requirements because of the recession, even though they've seen a surge in applicants.
Getting started
The first step should be to tell your doctor you need help. He or she often can give you free samples provided by drug companies, although some doctors say that they're getting fewer samples now, just when they have more patients asking for them.
A good next step is to do an Internet search for "patient assistance programs," or go to one of several Web sites sponsored by hospitals, consumer groups, drugmakers and others, that connect patients with individual assistance programs.
Those portals include
- RxHope
- NeedyMeds
- Patient Assistance Programs - Prescription Drugs for the Uninsured
- Patient Advocate Foundation
- and the industry-backed Partnership for Prescription Assistance.
Some have links to coupons for rebates or free samples, or to programs such as Together Rx Access. It supplies cards that people who don't have drug coverage and aren't eligible for Medicare can use in nearly all pharmacies to get discounts of 25-40 percent on prescriptions.
Readying your applications
Before applying, assemble the documents you likely will need to get approval for a patient assistance program:
- Your last income tax return and, if you're employed, recent pay stubs.
- If you're unemployed, a letter or other document from your former employer stating you have been terminated and your health insurance has been stopped.
- Your last few months of bank statements.
- Statements covering any investments you have.
- Information on accumulated medical debt, which could affect eligibility.
Don’t be shy
Patients who have been through the process say not to accept rejection as final. Sometimes writing a letter detailing why a medication is so important, or applying to additional programs, brings success.
Once you've gotten approval, though, you'll almost definitely have to reapply every year. That can cause a gap without the medicine, so don't wait until the last minute.
Besides helping get medications free from a manufacturer or charity, assistance programs often help patients get qualified for Medicaid, which covers poor and disabled people, or other government health programs.
The Patient Advocate Foundation will appeal denials to try to reverse them, help people get Social Security disability income or Medicaid coverage, and get preauthorization for expensive medical care. It does so using case managers trained in the ins and outs of specific issues.
"For people that need case management to get resolution, 98 percent get what they need" or close to it, said the foundation's chief executive, Nancy Davenport-Ennis.
Even people with health insurance can sometimes find help, such as when they need medicines for cancer or other complex illnesses that can cost tens of thousands of dollars a year, or when they have special circumstances.
Gerler, the Missouri day care operator, and her husband pay $750 a month for individual health insurance for the family of five. However, the plan, which they bought 1 1/2 years after Taegan was born, excludes coverage for pre-existing respiratory and ear problems for Taegan, 5.
Gerler managed on her own to get approval for Singulair, an asthma and allergy drug that had cost her $90 a month, free from manufacturer Merck & Co. She got free samples of some other allergy pills, and a ProAir albuterol inhaler from doctors. But when Taegan's pediatrician last fall also prescribed an Advair inhaler, costing $200 a month, she got nowhere, despite appeals to about 20 people at the manufacturer and various patient advocacy groups.
"Everyone said, 'If you have insurance, we can't help you,'" she recalled.
Finally, she found a Patient Advocate Foundation caseworker who "knew what to say to get what she wanted." Gerler had to provide the insurance policy rider showing what care was excluded, and even go through applying for and being rejected by Medicaid. Still, the foundation got drugmaker GlaxoSmithKline PLC to provide Advair inhalers free within a month.
"I was jumping up and down when I found out," Gerler said last week. "She's been healthy all winter long. I just couldn't ask for more than that."
