Wednesday, January 6, 2016

The five trips were worth it, even though I still don't have the medicine

Not much to update since the post about my fifth trip to the pharmacy to pick up our prescription using a new manufacturer copay assistance program. Our dietician has been wonderful, working late trying to help other families realize the benefit of this program and helping us to navigate the obstacles that accompany anything new. She called me this afternoon to let me know where she was with talking to the drug rep and figuring this out, and we talked for a bit about how we might help others to realize the benefits of this and other drug manufacturer programs. I mentioned that we don't typically qualify for patient assistance programs as they are often income based, but we discussed how there seems to be a difference between co-pay assistance programs and financial assistance programs. Give the prevalence of high decuctible insurance plans, many companies are offering these co-pay cards now and they help out tremendously.

After I got off the phone with her I did a little digging and I just have to share what I've accomplished with about 4 phone calls over the past 3 hours, both because i'm excited by and proud of it, but also because I hope someone reading this will be able to do the same! I got co-pay assistance for two more of Drew's medications, Pulmozyme and Tobi, and here's how:

I got aPulmozyme co-pay card quite easily with this link I was able to print it out as soon as I filled out the information. The only hiccup was when filling out the information for the card I had to use my name rather than Drew's because someone older than 18 was required to do it. With our insurance (CVS Caremark Specialty) and our new HSA plan, the out of pocket cost of the medication for us would be $2964/mo, and using the co-pay card the cost to me will be $30 and $2934 will be paid by Pulmozyme toward my deductible. This only works with a 30 day supply, not 90, and is good for covering up to $10,000 in a 12mo. period.

Tobi also has a co-pay program for people with high deductible plans and with no government insurance. You have to call them at 877-999-8624. Online it is advertised as being for Tobi Podhaler but they also cover the nebulized solution. They give you a card number on the spot and all the other information you need to give to the pharmacy but do not have a physical card that they send to you or that you can download. You also can only use this on brand name Tobi, not a generic substitution. This also only works on a 30 day supply, but will cover up to $14,000 annually and renews automatically. The cost with our insurance for a month supply of Tobi is a little over $3,000 and with this co-pay card the cost will be $4 and Tobi will pay $3000 toward our deductible. 

So the GREAT news here is that between his Creon, Pulmozyme and Tobi, Drew will meet his deductible when I get the prescriptions filled later this week. This means our families out of pocket expenses have been cut WAY down for his care. The value of doing this first thing in January is that his deductible is met before he has any other medical expenses for us to pay out of pocket. And dare I call it easy? Without the struggle to get the Creon prescription filled, I would never have had the conversation I had with his wonderful dietician to become aware of other manufacturer co-pay programs or explore them to see what the opportunity might be for us. So while it may be the only thing that I accomplished today, it saved us more than $6,000 in prescription expense this month and in doing so lowered the cost for all medical expenses for the rest of the year. The only thing that could have been better is if I still had Better to do it for me. That's another blog post altogether, but the long and short of it is that most people don't have the time or energy to spend half a day digging and calling and calling back and sharing and learning, and a company like Better, something that truly helped to lighten the cognitive load for patients by taking on these important and time consuming tasks could really help the whole healthcare system in a real way. I was so sad to see them go, I just don't think the world realized just how valuable this service is, to patients and ultimately the entire healthcare system. I miss you, Better! 

No comments:

Post a Comment