How To Find Help Controlling Your Prescription Drug Costs

By: 
Mary Green

According to the U.S. Center for Disease Control’s National Center for Health Statistics, an astounding 90 percent of Americans now have health insurance, thanks in large part to the Patient Protection and Affordable Care Act, more commonly known as Obamacare. While that number is impressive, it’s not the whole story.

Along with an increase in the number of insured citizens has come an increase in dollars spent on prescription drugs in the U.S., nearly $374 billion in 2014, the most recent year for which data is available.

Even with insurance, prescription drug purchases can be expensive, to say nothing of additional medical supplies that may be necessary to treat a chronic medical condition. There are a number of factors that contribute to this phenomenon.

First, drug prices in the U.S. typically are higher than in other countries, where universal health care systems allow government agencies to regulate the prices of medicines and set a limit on the amount they will reimburse. By contrast, in the U.S., such bargaining power only exists for Medicaid and the Department of Veteran Affairs. Thus, insurers have much less leverage to negotiate a lower price on drugs, especially with specialty medicines created by a single manufacturer, which leads to monopoly pricing. Insurers subsequently shift the costs to policy holders.

Also complicating the situation is the U.S. Food and Drug Administration’s (FDA) exacting standards for generic versions of off-patent drugs, which consumers often turn to reduce their out-of-pocket medicine costs. Before gaining approval, generics must first meet the FDA’s stringent requirements. The product must contain the same active ingredients as the brand-name drug; be identical in strength, dosage form and route of administration; be absorbed into the bloodstream at a similar rate and over the same period of time; and meet the same requirements for strength, purity and quality. Plus, the process can be protracted: According to trade group the Generic Pharmaceutical Association, the length of time it takes the FDA to approve a generic is now 47 months.

And pharmaceutical research is becoming increasingly expensive. Various research studies suggests it can take as much as a decade and anywhere from $1 billion to $2.5 billion to get a new drug approved by the FDA...and that includes development costs for many drugs that failed during clinical trials and can’t be brought to market.

As a consequence of these combined factors, the cost of prescription drugs is well on its way to making health care unaffordable again. For many fixed-income and low-income Americans, that oftentimes means making some difficult choices, forcing them to choose between groceries, rent or getting prescriptions filled. Some folks skip doses, while others stop filling their prescriptions altogether.

All in all, it’s a complicated scenario. Fortunately, Prescription Assistance Programs, or PAPs, have emerged to help patients acquire the medication they need.

Some PAPs are designed for people who lack health insurance. Others assist people who have insurance, but either their medications aren’t covered or their copayments are too burdensome. It’s important to note that each patient assistance program has its own set of rules and eligibility requirements and often require submission of personal information, such as proof of income, health insurance documents and information from your prescribing physician.

A terrific place to start your search for aid is at the website of the Partnership for Prescription Assistance (PPA): https://www.pparx.org/. This free, confidential, single-point-of-access clearinghouse helps connect underinsured and uninsured patients to programs that provide free or low-cost prescription drugs to qualifying individuals. The organization’s website claims to offer access to more than 475 public and private patient assistance programs, including nearly 200 programs offered by biopharmaceutical companies themselves. PPA participating member programs offer access to more than 2,500 medicines, including a wide range of generics. The site additionally offers information regarding programs that assist with supplies and services such as glucose meters, test strips, insulin syringes, medical testing, even service animals.

Keep in mind that the Partnership for Prescription Assistance is an information resource only and does not directly offer the assistance programs; you must apply directly to the program(s) for aid.

Another helpful resource is NeedyMeds (www.needymeds.org), a national non-profit whose mission is to provide information on healthcare programs, offering direct assistance and facilitating programs. The organization regularly updates its data on more than 9,000 assistance programs and nearly 1,500 drug discount coupons. NeedyMeds also provides a free drug discount card that offers a discount of up to 80 percent at more than 65,000 pharmacies nationwide. Anyone can use the card regardless of income level or insurance status, and no registration is required. The same card can be used by friends and family members to save on prescription drugs, over-the-counter drugs and medical supplies written on a prescription form.

RX Assist (www.rxassist.org) is a comprehensive resource center for patients, providers and patient advocates to find free and low-cost medications to help manage chronic diseases. The site features a searchable database for discounted or free medication by drug, brand or company name. It also provides links to programs that offer free or low-cost healthcare, ranging from community health centers and free clinics to social services agencies and programs. It includes a learning center where visitors can learn more about healthcare reform issues, connect with care providers about medication access, and browse a library of fact sheets, how-to guides and other relevant information.

It’s important to note that there are a number of online programs that offer to assist patients with the completion of paperwork necessary for PAPs, but unlike the organizations listed above, some may charge for their services. Be sure you’re working with an organization that offers its services for free.

If you or someone you know is struggling with affordable access to prescriptions, there’s a wealth of resources available to help them. And by reducing the financial stress associated, they can focus on what’s most important: their health.

For additional patient assistance resources information, visit: www.empoweryourhealth.org, click on the Resources tab and download the Patient Assistance Drug Program Directory PDF.