Hi! This is Christina, transplant specialty pharmacist, and Erin, social worker, here at Mayo Clinic. Through our jobs, we’ve had the opportunity to meet with hundreds of patients who are hoping to have a transplant or have had one. Each patient is unique, but one thing they all have in common is the need for life-long immunosuppressant medications after receiving their transplant. Unfortunately, these necessary medications can be expensive – even for people with good insurance. We’d like to offer you some “pro-tips” for bringing down the cost of medications when possible.
Pro-tip #1: Always Carry Prescription Insurance
On average, patients take about 30 pills a day after a transplant. The average cash price, meaning the estimated price without any insurance, of the medications is $2,000 per month. Even years after a transplant, the total cash price may remain $1,000 per month. For most folks, paying a monthly premium for prescription insurance is less expensive than paying out of pocket for medications. Typically, an insurance plan with more comprehensive coverage is preferred to a high deductible plan.
Review your insurance plan options carefully, and spend time learning about the prescription benefits coverage that comes with each plan. Low-income individuals who are not already enrolled in Medicaid (also known as Medical Assistance), should explore their state’s options and consider meeting with a county financial worker, social worker, and/or case manager. Other insurance options include employer-based insurance, private insurance, or insurance purchased through the Health Insurance Marketplace.
Pro-tip #2: Search for Coupons (Private Insurance Carriers)
Did you know drug companies offer coupons to help with the cost of certain medications? Usually the drug is a brand name prescription and the coupon helps cover the copay. Unfortunately, most drug coupons don’t work with government-based insurance such as Medicare and Medicaid. Drug company agents give the coupons to pharmacists or doctors to pass on to their patients, but there’s also a way that patients can find them on their own. There are several websites that compile links to many coupons, such as Good RX and Needy Meds.
Always be cautious when you’re looking for a medication coupon on the internet to avoid scams. Coupons from the drug company shouldn’t have any fee to use them. Also, if there is a generic version of your medication available, that may be less expensive than a brand name drug with a coupon. The coupons all have different rules including how many times it can be used, how much it will discount, and who is eligible, so read up on the specific rules of your coupon(s). If you find one you think will work for you, give the paperwork to your pharmacist when you drop off your prescription or ask for a refill and they should do the rest. By law, pharmacists can't apply coupons to medications you’ve already paid for.
For individuals with government-based insurance like Medicare, there could still be assistance available to you through the drug manufacturer. This is usually a more in-depth application and often requires the assistance of your transplant center’s social worker and/or nurse coordinator. If you have Medicare and you still have a large out-of-pocket cost, we recommend contacting either your social worker or nurse coordinator to further explore patient assistance programs.
Pro-tip #3: Prescription Discount Programs
In the event that you have a medication that your insurance doesn’t pay for, there are groups that offer prescription discount programs. One we commonly recommend is AARP. AARP Prescription Discounts, provided by OptumRx, is a prescription discount program that offers free exclusive discounts to AARP members, their spouses, and dependents including children, grandchildren and stepchildren. If you’re an AARP member, simply present your membership card to the pharmacy whenever there is a prescription that insurance doesn't pay anything toward. The pharmacist or their staff would submit the prescription insurance information to AARP to see if it qualifies for a discount. Not all medications qualify, but AARP states their average savings is 60 percent.
Another resource is AAA which is usually associated with automotive related benefits. They also have a prescription discount with membership, though their average cost savings is lower at 31 percent. Similar to AARP, present your AAA card at the pharmacy when there is a prescription that insurance does not pay toward and the pharmacy staff will check to see if it qualifies for a discount.
Pro-tip #4: Leverage your Pharmacy Benefits Coverage
Not only are you looking for ways to save money, but so are your insurers. Many have programs to help reduce costs which can feed back to you by decreasing your prescription costs. One of the most commonly offered programs are mail order pharmacies. With certain chronic medications, meaning medications you take daily for a long time, insurers with a mail order option will charge you a lower copay if you send that prescription to their mail order pharmacy. Usually these prescriptions are for a 90 day supply.
Another way to leverage your pharmacy benefits coverage is through your medication formulary. The formulary, which is a fancy name for a list of medications your insurer prefers you use, has tiers built into it. The drugs that your insurance company’s team of doctors, nurses, and pharmacists believes is the most cost-effective (meaning best “bang for your buck”) go into the preferred tier. The preferred tier has drugs with the lowest copay. Most insurance companies publish their formulary online or you can call a representative to find out what tier a medication falls into. If you find that your prescription is in a non-preferred tier, ask your insurance representative about the preferred alternative. You can take that information back to your prescriber to discuss if the alternative would work for you or not.
Pro-tip #5: Speak up to your Health Care Providers about Cost
Unfortunately, there’s a major disconnect between the care providers who prescribe medications and the cost of those medications. We’ve heard many times from doctors that they didn’t know that a prescription was very expensive for their patient. It can be hard for doctors to figure out which medications are expensive because even common, generic medications can be surprisingly costly. You should feel empowered to let your doctor know if a drug cost is stretching your pocketbook. They may be able to figure out a different alternative. If you aren’t sure about how to initiate the conversation, ask your pharmacist if they know of less expensive options to write down for you to take to your next doctor’s appointment. As discussed above, you could also get a list of preferred medication alternatives from your insurance company when available.
Pro-tip #6: Do NOT Miss Doses of your Medications
This pro-tip may not seem obvious - how does taking medications help to decrease cost? The trick here is that your doctors almost always assume that you’re taking your medications exactly as prescribed. So what happens if you haven’t reached the goal they have set out for you with that medication? They will add another medication.
For example, “Tom” is on a blood pressure medication he takes twice daily, but is missing the second dose because he is busy in the evenings. Tom’s blood pressure is lower than before taking the medication, but not at the goal blood pressure numbers. Tom’s doctor adds a second medication that is three times per day. Tom doesn’t think to or want to admit that he isn’t taking the first medication faithfully to his doctor, so he commits to taking yet another medication for blood pressure resulting in more pills and cost.
Unfortunately, we see this happen commonly with patients. The moral of the story is to take your medications as prescribed and if you're having trouble doing this, talk with your doctor about it so they can help figure out a different solution than adding more medications.
Pro-tip #7: Select Over the Counter Medications Carefully
It’s been shown that Americans spend more money on herbal medications and supplements than they do on all prescription medications. Herbal products and supplements sold over the counter are not tested or approved by the Federal Drug Administration. At this time, no studies are required to prove these products are safe, that they work, or if they contain the ingredients on the label. In fact, research has shown these products often use fillers, have chemicals not listed on the label, and may have contaminants.
There are times when supplements may help and are recommended by your doctor. In those cases, look for “USP Verified Mark” on the bottle. This verifies the product will break down and release into the body in the specified amount of time, that it contains the ingredients listed on the label, in the amount listed, and that it doesn’t contain harmful levels of contaminants. If a supplement or vitamin was not recommended by your medical doctor, then you may want to evaluate if it’s worth the cost. Bring the bottle to your doctor or pharmacist and ask them if there’s good enough evidence for you to take it. If there isn’t, this could be an opportunity to spend less by stopping taking something that’s unnecessary.
Pro-tip #8: Look into Possible Resources
Here are links to programs that may be helpful to you:
Hepatic Encephalopathy Living Program: For those with confusion due to liver disease.
American Liver Foundation Drug Discount Card: For liver transplant patients.
National Organization for Rare Diseases: Patient must be diagnosed with one of the rare diseases that the Medication Assistance Program provides assistance for.
Assistance Programs through Drug Manufacturers:
Pfizer Rx Pathways: For uninsured.
Have you found a tip that works for you regarding your medications? Share with us below.