The cost of prescription medications is sky high and going higher. Many fixed- and low-income people find it an increasingly difficult task to pay for the medications they need to stay healthy. In many cases, it’s a choice between medicine and other necessities, such as food and heat.
If you find yourself or someone you know in this situation, there is help available to provide medications at no cost or low cost. This article discusses the following topics:
- Eligibility for prescription help
- Online assistance with prescription medications from the pharmaceutical companies
- Assistance with prescription medications from the pharmaceutical companies by telephone
- Medicare Rx extra help
- The State Health Insurance Assistance Program (SHIP)
- Samples from your doctor
- Reducing the cost: Mail-order and online medications
- Reducing the cost: Comparisons of pharmacy costs
Eligibility for prescription help
Means-testing for getting help
There is strict means-testing for getting help with prescription medications, whether it’s a government program or a pharmaceutical company program. The requirements vary by state and by company. But in general, you may expect requirements such as:
- You have no insurance coverage for the medication
- You are not eligible for Medicare, or Medicare will not cover the drug
- Your household income is below a certain threshold, usually quite low or even the poverty level
- Purchasing the drugs at retail would be a hardship for you due to your income and/or expenses
The National Council on Aging has a website called BenefitsCheckUp that will help you find federal, state, local and private programs that will help you with your prescription drugs and other needs. You can also apply for Medicare Rx Extra Help at this site. The information you will need to check on benefits for prescription drugs is:
- ZIP code
- Date of birth
- Type of residence (house, apartment, or mobile home)
- Approximate out-of-pocket dollar amount paid for prescription drugs and medical expenses
- Types of public benefits and prescription drug savings programs currently received
- Current income and assets from all sources for self and spouse and others in the household
- Veteran and TRICARE status for self and spouse
- Names of prescription medications you are taking (I recommend that you have available the prescription bottles or information about your medications from your health professional)
Online assistance with prescription medications from the pharmaceutical companies
Online help from the pharmaceutical companies
Low-income people may be able to get help with their medication costs, or even get their medications for free, from pharmaceutical companies. There are a number of resources for doing so, both online and by telephone.
The website NeedyMeds.org provides help in finding patient assistance programs for your particular drug, as well as a host of other services helpful to low-income users. Among the services that it provides for finding drug assistance are:
- Information about drug programs by the drug’s brand name or generic name
- Patient Assistance program list
- Company list with contact information (much more comprehensive than the list below)
- Patient Assistant application forms for many companies
- Medication Coupons for free brand name drugs
- Application assistance by state
- Discount drug cards
- Lists of government, Medicare, and SHIP sites
- Guidelines for means-testing
Another online resource is the Partnership for Prescription Assistance website. It is an organization that brings together Americaâ€™s pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups. Their goal is to help qualifying patients who lack prescription coverage to get the medicines they need through the public or private programs. The website is geared not only to the patient, but to caregivers and doctors who prescribe medications. It is not as easy to use as NeedyMeds.org, but is very thorough as it walks you through finding the drug, abbreviated means-testing, and listing of several ways to obtain the medication.
Assistance with prescription medications from the pharmaceutical companies by telephone
Help by telephone from pharmaceutical companies
In the US, the Pharmaceutical Manufacturers Association (PMA) publishes a directory of medication assistance programs. Doctors can get a copy of the PMA’s official guide by calling (800) PMA-INFO. You or your doctor can also call the company that makes your medication directly to learn more about their low-income assistance programs. Following is a list of phone numbers:
- 3M Pharmaceuticals (800) 328-0255
- Allergan Prescription (800) 347-4500
- Alza Pharmaceuticals (415) 962-4243
- Amgen (800) 272-9376
- Astra USA (800) 488-3247
- Berlex (800) 423-7539
- Boehringer Ingleheim (203) 798-4131
- Bristol Myers Squibb (800) 736-0003
- Burroughs-Wellcome (800) 722-9294
- Ciba-Geigy Patient Support Program (800) 257-3273 or (908) 277-5849
- Eli-Lilly (317) 276-2950
- Genetech (800) 879-4747
- Glaxo (800) 452-7677
- Hoechst-Roussel (800) 776-5463
- Hoffman-Larouche (800) 526-6367
- Ici-Stuart (302) 886-2231
- Immunex Corp. (800) 321-4669
- Janssen (800) 253-3682
- Johnson & Johnson (800) 447-3437
- Knoll (800) 526-0710
- Lederle (800) 526-7870
- Lilly Cares Program (800) 545-6962
- Marion Merrel Dow (800) 362-7466
- McNeil Pharmaceuticals (800) 682-6532
- Merck Human Health (800) 672-6372
- Miles (800) 998-9180
- Ortho Pharmaceuticals (800) 682-6532
- Parke-Davis (202) 540-2000
- Pfizer Indigent Patient Program (800) 646-4455
- Pharmacia (800) 795-9759
- Proctor & Gamble (800) 448-4878
- Rhone-Poulenc Rorer (610) 454-8298
- Roche Labs (800) 285-4484
- Roxane Labs (800) 274-8651
- Sandoz (800) 937-6673
- Sanofi Winthrop (800) 446-6267
- Schering Labs (800) 521-7157
- Searle (800) 542-2526
- Serono (617) 982-9000
- SmithKline Access to Care Program (800) 546-0420 (patient requests) or (215) 751-5722 (physician requests)
- Solvay Patient Assistance Program (800) 788-9277
- Survanta Lifeline (800) 922-3255
- Syntex Labs (800) 822-8255
- UpJohn Co.(800) 242-7014
- Wyeth-Ayerst (703) 706-5933
- Zeneca Pharmaceuticals (800) 424-372
Medicare Rx extra help
Extra help from Medicare for drugs
If you have Medicare and have a limited income and resources, you may be able to get extra help paying for your Medicare prescription drug costs. Your income must be less than $15,600 if single and $21,000 if married and you must have resources less than $11,990 if single and $23,970 if married. Resource limits include a $1,500 burial allowance for singles and a $3,000 burial allowance for couples. If you qualify, you will have low or no deductible, low or no premiums, no coverage gap (also called the “donut hole”), and will pay much less for your prescriptions.
During the Open Enrollment period, which runs from November 15 to December 31, it is best to sign up with a drug plan before you know whether you qualify for Extra Help. If your application for Extra Help is denied and you didnâ€™t enroll in a drug plan during the open enrollment period, you wonâ€™t be able to enroll until November 2007 and your coverage wonâ€™t start until January 2008. Youâ€™ll likely pay a higher penalty if you were eligible to enroll earlier, but chose not to do so. And youâ€™ll pay this penalty for as long as you have Part D. Even without the Extra Help, youâ€™ll likely save on the cost of your drugs by enrolling in a Medicare drug plan.
Visit BenefitsCheckUp to apply for Medicare Rx extra help. Also available is the AARP Extra Help Application Center at 800-985-6848.
The State Health Insurance Assistance Program (SHIP)
SHIP provides Medicare information and help
The State Health Insurance Assistance Program, or SHIP, is a national program that offers one-on-one counseling and assistance to people with Medicare and their families. Through federal grants directed to states, SHIPs provide free counseling and assistance via telephone and face-to-face interactive sessions.Â
SHIPÂ is an independent program funded by federal agencies and is not affiliated with the insurance industry.This program is a partnership of the Department of Economic Security Division of Aging and Adult Services and the Area Agencies on Aging.
When you contact your state or regional SHIP office, you will be linked with a local SHIP counselor, who can meet with you and help you with:
- Medicare Eligibility, Benefits and claim filing
- Medicaid (AHCCCS) Eligibility, Benefits and claim filing
- Medicare Part D (Medicare Prescription Drug Coverage)
- Long Term Care Insurance information
- Medicare Secondary Payor
- Other types of health insurance benefits
- Medigap insurance
- Medicare Advantage Plan options and enrollment
- Medicare Cost Sharing Programs and other Dual Eligible enrollment
- Medicare/Medicaid Fraud, Waste and Abuse
- Information regardingÂ Medicare Costs and DeductiblesÂ
The SHIPtalk website helps you find your state or regional SHIP office. There you will find contact addresses, telephone number and email addresses. You can also find local SHIP counselors on the site.
Samples from your doctor
Ask your doctor for samples
Your doctor may be able to give you drug samples to tide you over until you can afford to purchase the medications. All you have to do is ask! Of course, this is only a stopgap measure, but it can help for a while.
Reducing the cost: Mail-order and online medications
Mail-order or online drugs can reduce costs
You can often reduce the cost of your monthly medication bills by using a mail-order or internet pharmacy. They can mail your prescription to you at substantial savings over many local drug stores. Medications may be available from other countries as well. These can be very inexpensive compared to in-country costs.
Your doctor likely will have to fill out some paperwork before you can use these mail-order services. As with any other transaction by mail or over the internet, you will need to check the company’s reputation and quality of service before sending money or using your credit card. You will need to check customs regulations if dealing with out-of-country pharmacies, as well, especially if the drug is not sold in your country.
Communicating with these companies is usually done via fax, email or telephone. Some have online ordering. These companies normally will send you a three-month supply of the medications you need.
Ask your friends, your doctor or your insurance company for recommendations of mail-order pharmacies. Some insurance companies, such as some Blue Cross-Blue Shield companies, require medications to be purchased through a specific mail-order company.
Reducing the cost: Comparisons of pharmacy costs
Shop around for the best price
Consumer Reports magazine did an extensive report in June, 2008 called “America’s Best Drugstores” that rated chain and local, and some mail-order and online pharmacies for service and price. Your local library ought to have this recent issue of the magazine. The online version of the report, unfortunately, is by subscription only.Â
Part of the article dealt with prices for a group of common prescription medications. The cost ranged from under $1000 to over $1300. Costco came in the lowest at $962, with AARP.com at $1005, and WalMart third at $1073. The most expensive was Rite Aid at $1302 for the same medications. Independent drugstores averaged $1192. Note that local drugstores will sometimes match the price of cheaper pharmacies to keep your business.
For those unable to purchase the medications they need, there is help both online and by phone. However, there is a means test for every drug and every company or agency, so be prepared for some paperwork.
Prescription medications are not cheap, whatever bargains are to be found. It pays to shop around. However, I cannot emphasize enough that you need to verify the reputation and reliability of mail-order and online pharmacies before you send any money to them. Ask your friends or your doctor for recommendations. Check with your library for publications that list trusted sources.Â
Above all, realize that there are alternatives to paying the full retail price for many medications. It just takes a little research and diligence!
What do you think?
There is help available, but it comes at a cost: filling out forms. There’s no way around it, but if it’s your only way of getting the medications you need, you have little choice. It seems a shame that our nation’s most vulnerable should have to wade through piles of red tape to stay healthy. It looks like there could be a central clearing house where a person could apply once, and if approved, get their medications from the various manufacturers and agencies.
- What do you think of the clearing house idea?
- Do you have any experience getting low- or no-cost drug assistance?
- Have you ever used online pharmacies? What is your experience?
As always, your comments are welcome!
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Resources used in this post:
McGregor, Sherrie. (2007, January 21). Financial Help with Medications. Retrieved June 27, 2008 from PsychCentral: http://psychcentral.com/lib/2007/financial-help-with-medications/
Revised December 10, 2008