This month's guest blogger is Julie Adkison, PharmD, BCACP, CDCES. Julie has been on the faculty of the Memorial Family Medicine Residency Program in Sugar Land, Texas for almost 20 years. Julie teaches the full scope of primary care pharmacotherapy to family medicine residents and specializes in diabetes care. She supervises a weekly specialty diabetes clinic, monthly shared medical visits, and provides individual consults as needed. Julie enjoys teaching young physicians to embrace the challenge and reward of managing complex patients.
Resources for Medication Cost Savings
Designing affordable medication regimens is not only important in treating diabetes, but can become a challenge when also addressing related comorbidities such as hypertension, hyperlipidemia and neuropathy. While prescribing generic medications can amount to significant cost savings over brand name drugs, the cost of a long drug list can add up quickly and be a barrier to patients achieving their health goals.
There are a number of resources available to patients to help lower their out-of-pocket medication costs, but knowing the best option for a particular patient can be tricky. Let’s break down the differences between discount drug lists, pharmacy discount cards, manufacturer’s copay coupons and patient assistance programs.
In our practice, we tend to refer to all discount drug lists as “the $4 list,” but in reality, there is variation among the various pharmacies when it comes to the scope of included drugs and prices. Walmart and HEB have a set list of medications that are discounted for any patient, while Walgreens and Kroger have Prescription Savings Clubs which require an annual fee with individual and family plans ($20/yr and $36/yr, respectively for individual plans). Walmart’s list is the most limited but possibly the best known, while Kroger seems to be the most comprehensive. Some chronic medications on the Kroger list are completely free. Members of the Kroger Savings Club can also receive a free store brand glucometer annually. The matching test strips are sold in boxes of 100 for $3. Patients should be encouraged to compare the cost of their exact medication list by looking at the program websites for each pharmacy.
You’re likely also familiar with GoodRx, which is one of many pharmacy discount programs. Similar programs include WellRx, America’s Pharmacy and RxSaver. The biggest cost savings with these programs are seen with generic medications, as the discount on brand name drugs is quite small. These cards or phone apps allow patients to compare the discounted cash price of drugs at most retail pharmacies. Patients must register the card or app and present it at the pharmacy like an insurance card. Coupon codes are entered by the pharmacy tech in order to validate the discounted price. Smaller or independently owned pharmacies may not participate in these programs because the pharmacy may lose money when filling prescriptions using the discount codes.
For patients with private insurance, drug company co-pay coupons or rebates can offer significant savings on out of pocket costs of brand name medications. These coupons cannot be used with government funded insurance such as Medicare or Medicaid. Patients must register their name, address, date of birth and email address on the manufacturer’s website. There is usually a maximum amount that the co-pay will be discounted or reduced, and each co-pay coupon or rebate program is different. Patients can look up their specific drug on the manufacturer’s website in order to learn the details and enroll.
Lastly, patient assistance programs (PAP) are created by pharmaceutical companies to provide free or discounted medicines to people who are unable to afford them. Each program has its own qualifying criteria. Websites such as needymeds.org and rxassist.org are online information resources which make locating the requirements and features of each program easier to find.
On these sites, a patient may search for the name of medication and then be linked to the exact PAP application. The amount of information required by each company varies. Some ask for detailed medical and financial proof while others ask for very little. Commonly, paycheck documentation or tax returns are needed for the annual application. Once physician signatures or prescriptions are obtained and the application is approved, a 90-day supply of the medication may be shipped to the patients’ home or to the physician’s office. Although the application process can feel cumbersome, these programs help many people get medication that would otherwise be out of reach.
Getinsulin.org was recently launched to help people with diabetes in the US get access to insulin and affordability options that match their unique circumstances. Patients answer questions about their location, insurance, income and type of insulin to receive a customized action plan. This resource does not provide insulin directly, but helps identify and streamline solutions for obtaining insulin.
By knowing the options available, diabetes care and education specialists can be another voice on the healthcare team offering suggestions and providing solutions to the barrier of high prescription drug costs.
Comment below any questions or feel free to contact Julie directly here.