Guide for Helping Patients Afford Their Medications

Full update July 2019

Medication adherence is a huge focus in healthcare. Adherence helps keep patients healthy. Improving adherence rates has the potential to save billions of healthcare dollars. However, the inability to afford medications is a known adherence barrier. There are many ways to help patients afford their medications, from tweaking regimens to helping them find assistance programs. This document has cost-saving tips you can use, as well as a list of programs and other helpful resources to recommend to patients. Note that the lists may not be all-inclusive of such programs.

Cost-Saving Tips

Review patients’ medications. Look for:

  • Duplicates or overlapping medications or supplements that can be eliminated.
  • Brand products that can be switched to generics or therapeutic alternatives.
  • Medications that are being used to treat preventable side effects of other meds.
  • Additional switches that can make medications more affordable. Check Consumer Reports Best Buy Drugs (https://www.consumerreports.org/health/drugs-a-z/best-buy-drugs/index.htm/) for best value meds for treating specific disease states as well as other cost-saving tips such as cost-effective over-the-counter (OTC) alternatives to some Rx drugs.

Recommend tablet splitting when appropriate, for meds that are priced similarly between strengths.

Suggest purchasing larger quantities of medication at one time. A 90-day supply may cost less and reduce co-pays compared to a 30-day supply.

Drug samples and co-pay coupons can save patients money upfront. However, they can cost patients more in the long run. Patients get stabilized on these meds, which are often more expensive. With co-pay coupons, the patient may not realize what the true co-pay for the drug will be until the coupon expires or the max amount covered by the coupon is reached. Save samples and coupons for medications that don’t have more affordable alternatives, or for short-term meds such as antibiotics. Co-pay coupons can’t be used by patients with government-funded drug coverage (e.g., Medicare, Medicaid, TRICARE).

Discount or savings cards are typically used as an alternative to insurance, although requirements for eligibility can vary. Encourage patients to ask if their pharmacy has their own discount program.

Assistance programs (e.g., state programs, drug company programs) vary and may have income requirements. These may help with costs when patients are in the “donut hole.” Some organizations, like the Leukemia and Lymphoma Society, will help patients pay for the cost of treatments for specific diseases. Note that not all money paid by assistance programs contributes to out-of-pocket expenses for Medicare Part D participants. For example, money paid by state-sponsored programs or charitable organizations will typically count, whereas money paid by manufacturers’ programs may not. Help patients understand the fine print with any of these programs. For example, there may be expiration dates, limits on amounts, or exclusions (e.g., patients with government-funded insurance). There are also concerns that some of these programs may increase overall healthcare costs or insurance premiums.

—Continue for a list web-based resources for savings on medications —

Web-based Resources for Savings on Medications

Information Source

Comments

American Diabetes Association
www.diabetes.org

Site provides a list of several discount programs and diabetes-specific patient assistance programs at: www.diabetes.org/living-with-diabetes/health-insurance/prescription-assistance.html.

Blink Health
www.blinkhealth.com
844-366-2211

Negotiates with the pharmaceutical industry to allow for lower medication prices. Patients search for their medication on the site. Written or electronic prescriptions are provided to a participating pharmacy (e.g., Costco, Walmart, Publix). Patients pay online through the Blink Health site, and either pick up their medication at the pharmacy or have it delivered to their home.

Benefits Checkup
www.benefitscheckup.org

Site provides a personalized report of public and private programs available to help reduce costs of prescription drugs. Also includes online application for Medicare Low Income Subsidy known as Extra Help. Service provided by the National Council on Aging.

FamilyWize
www.familywize.org
800-222-2818

Site allows drug price comparisons between pharmacies for a specific drug. Has a newsletter available to sign up for. Also includes a free discount card that can be sent via email or text message.

GoodRx
www.goodrx.com
855-268-2822

Site allows drug price comparisons between pharmacies for a specific drug. Has a free app for iPhone or Android that has this functionality in addition to access to drug coupons. Also includes a free discount card that can be ordered via mail and other helpful tools such as a pill identifier and savings opportunities on pet meds.

InsideRx
www.insiderx.com

Site allows drug price comparisons between pharmacies for a specific drug. Has drug information, including information about dosing and possible side effects. Provides information about pet medications. Also includes a free discount card that can be printed out or sent via email or text message.

Medicare
Medicare.gov
800-MEDICAR

Has a searchable database for state programs that help Medicare patients pay for prescription drug plan premiums and other costs: http://www.medicare.gov/pharmaceutical-assistance-program/state-programs.aspx. In addition, has a search available to find assistance programs from manufacturers: www.medicare.gov/pharmaceutical-assistance-program/index.aspx.

Medicine Assistance Tool
www.medicineassistancetool.org

Site provides a search engine designed to identify available resources through manufacturer patient assistance programs and resources. Also includes links to additional organizations and resources on various chronic diseases (e.g., aging, cancer, kidney failure).

Web-based Resources for Savings on Medications

NeedyMeds
www.needymeds.org
800-503-6897

Site lists brand and generic drugs available through patient assistance programs, as well as diagnosis-based assistance information. There is a list of manufacturers with patient assistance programs. Information about Medicaid, Medicare, and other state assistance programs is also available. Also includes a free drug discount card that can be ordered via mail.

RxAssist
www.rxassist.org
877-537-5537

Site provides information on patient assistance programs through manufacturer, brand, and generic drug name search. Has information for patients describing various options for Rx assistance. Also includes a free drug discount card that can be printed from their website.

RxHope
www.rxhope.com

Site provides patient assistance information through manufacturer or drug name search. Advanced search available to help patients determine eligibility for state- and company-sponsored patient assistance programs.

SingleCare
www.singlecare.com

Site allows drug price comparisons between pharmacies for a specific drug. Has a free app for iPhone or Android that has this functionality.

—Continue for a list of patient assistance and discount programs—

Patient Assistance and Discount Programs

Program

Eligibility

Enrollment

Formulary

Discount

AZ & ME
(AstraZeneca)

Individuals with qualifying incomes who:

  • Do not have Rx drug coverage OR
  • Have Medicare Part D

Medicare Part D participants may not be eligible or enrolled in Limited Income Subsidy (LIS) for Medicare Part D and are required to spend 3% of total household income on prescription medicines through Medicare Part D.

800-292-6363
or
www.azandmeapp.com

Many AstraZeneca prescription medicines

Medication is free. Refills must be obtained through mail order.

GSK For You
(GlaxoSmithKline)

Combines previous programs such as GSK Vaccine Access, GSK Bridges to Access, and GSK Access

Individuals with qualifying incomes who:

  • Do not have Rx drug coverage OR
  • Have Medicare Part D

Medicare Part D participants must meet income eligibility requirements and have spent at least $600 on medicines through a Medicare Part D Prescription drug plan.

Adults at least 19 years old without third party vaccine coverage who meet income requirements may be eligible for the GSK vaccine assistance program.

866-475-3678
or
www.gskforyou.com

Many GSK prescription medicines

Medication is free. Refills must be obtained through mail order.

Lilly Cares
(Eli Lilly)

Individuals with qualifying incomes who:

  • Do not have Rx drug coverage OR
  • Have Medicare Part D

Medicare Part D participants must meet income eligibility requirements and have spent at least $1,100 on medicines through a Medicare Part D Prescription drug plan (does not apply to Forteo, Humatrope, Olumiant, or Taltz).

800-545-6962
or
www.lillycares.com

Many Lilly prescription medicines

Medication is free. Refills must be obtained through mail order.

Lilly Cares Oncology
(Eli Lilly)

Individuals prescribed a Lilly oncology medication with qualifying incomes who:

  • Do not have Rx drug coverage OR
  • Have Medicare Part D

800-545-6962
or
www.lillycares.com

Many Lilly oncology prescription medicines

Medication is free. Refills must be obtained through mail order.

Merck Patient Assistance Program
(Merck)

Those with no insurance or Rx drug coverage who meet income requirements. Exceptions can be requested.

800-727-5400
or
www.merckhelps.com

Many Merck prescription medicines

Medication is free. Refills must be obtained through mail order.

Merck Vaccine Patient Assistance Program
(Merck)

Adults (primarily those without insurance) who without assistance could not afford necessary vaccines.

800-293-3881
or
www.merckhelps.com

Merck vaccines for adults

Vaccines are free.

Patient Access Network

Those with Rx drug coverage who meet income requirements.

Some programs are available to people with Medicare or commercial insurance, and some programs are restricted to patients enrolled in Medicare.

866-316-7263
or
https://www.panfoundation.org/index.php/en/

A list of medications to treat specific conditions

Assistance with deductibles, co-pays, and coinsurance.

Pfizer Rx Pathways
(Pfizer)

Eligibility requirements vary by medication and type of assistance provided.

844-989-7284
or
www.pfizerrxpathways.com

Many Pfizer prescription medicines

Prescriptions are free, discounted, or co-pay assistance may be provided.

WellCard Savings
(Access One Consumer Health)

Everyone*

*Not available in Montana or Vermont.

https://www.wellcardsavings.com/public/pharmacy.aspx

All Rx drugs. Check website for participating pharmacies.

Average savings of 50% on drug prices in retail pharmacies or 20% on drug prices through mail order pharmacies.

Project Leader in preparation of this clinical resource (350710): Beth Bryant, Pharm.D., BCPS, Assistant Editor

Cite this document as follows: Clinical Resource, Guide for Helping Patients Afford Their Medications. Pharmacist’s Letter/Prescriber’s Letter. July 2019.

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