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using PAP programs to your advantage

Overpaying for Your Prescriptions? Here’s Proof You Don’t Have To

Prescriptions are expensive, but you have more resources available to help you cut those costs down than you think. Here, we’ll look at how one man saved $422 a month on his medication by leveraging a Patient Assistance Program (PAP)–and how you can get similar results.

(Yes, you did read that correctly: $422 a month!)

No one is immune to the high prices and feeling of bureaucracy that can sometimes shroud the world of healthcare and big pharma—not even Scott Heiser, who literally wrote the book on the subject.

The difference is that Scott knew what to do—and, by being here, that means you can, too.

In the past, Scott was hospitalized with deep vein thrombosis (DVT) and subsequent pulmonary embolism—i.e., a blood clot in the lungs. Scott recalls that the whole thing was a shock, kind of a “freak incident.” He talked with the physicians, who said he needed to be on a blood thinner for a year. 

Together, they discussed options: there was Warfarin, an older and relatively inexpensive prescription, or Eliquis, a newer-generation drug that was more costly. Each drug—as is true for them all*—had pros and cons: Scott learned it was easier to control bleeding and coagulate more quickly with Warfarin, but he’d also to test his blood often. With Eliquis, he wouldn’t have to test his blood, and he’d have the convenience of only taking one pill a day. Although an uncontrolled bleed was not likely in his case, if he faced one, it would take him longer to coagulate.

Because Scott’s risk factors were low for needing quick coagulation—and taking into account he only needed to be on the precautionary medication for a year—he and his doctor decided Eliquis was the best choice.

The problem? It was $432 a month. Because Scott knew about PAPs to reduce consumer costs, though, he was able to get that cost down to $10 a month.

That’s that mega monthly savings we’re talking about! Hardly chump-change. 

Let’s take a closer look at PAPs. 

PAPs: What You Need to Know

PAPs are offered by pharmacy manufacturers to provide financial assistance to those taking a particular drug and who meet certain requirements. While each PAP is different, they generally provide assistance to those who meet one or a combination of the following criteria:

  • Have a high deductible health plan
  • Have an income of at or below a certain point
  • Do not have health coverage

Just as qualifications for each PAP are different, so are their means of providing assistance and reducing consumer costs. Some will cover your copay. When this happens, the pharmaceutical company still bills your employer (if they provide your insurance) the full amount—that’s just business.

“Our whole philosophy is that you, as a consumer, should understand the cost being borne by the system and be aware so you can try to minimize that cost. Why? Easy: it will pay dividends to you in the long run by keeping your premiums low,” Scott says. “If your employer’s premiums don’t go up, they don’t raise them for you, either.”

How Scott Saved Over $5,000 

In the short game, though, Scott knows that money talks. And $10 is a whole lot more digestible than the alternative—which is an example of what makes PAPs so attractive.

Here’s how Scott secured the reduced rate:

  • He searched for the phone number of the manufacturer and called to ask if they offered any type of assistance program. (Spoiler alert: they did.)
  • He talked with the representative to see if he met the program requirements due to his high-deductible health plan. (Spoiler again: he did.)
  • The representative said he’d notify Scott’s pharmacy of his discount, which was good for 24-months. (That’s all, folks. Discount received.)

It took all of twenty minutes—for the online search and the phone call combined—for Scott to save more than $5,000 for the year he was on the drug (that, due to the timing of his hospitalization, he would’ve paid 100 percent out-of-pocket). 

Today, it’s not even necessary to do your own online investigation. Instead, you can simply visit RXHope.com. This free, reference-based website lists over 330 drugs for which PAPs are available; it’s all right there for you.

Note that your drug may or may not be on the list—and if it is, you may or may not qualify for the PAP—but isn’t taking a few minutes to check worth the effort? 

Discount Cards: Save $5, $50, or More!

Sometimes, a PAP may not be available for a drug you’ve been prescribed. In that case—and, really, in any case—Scott says he recommends utilizing a prescription drug coupon card. 

He recalls having a prescription for Fluorouracil, a mild chemotherapy topical. He brought his coupon card (SingleCare, in this case) to the pharmacy, knowing what discount he was eligible for. The pharmacist (from a big chain store) said the cream would be $200, but—good news!—the store offered a $50 coupon. 

Scott knew that with his coupon—one the pharmacist said he may not be able to accept because he couldn’t file it electronically through the store’s system—could save him $100. Ultimately, Scott requested the paperwork to file on his own, saving himself the extra $50.

The pharmacist wasn’t trying to pull a fast one; he was simply dispensing drugs and offering discounts in the manner in which he was trained. In fact, Scott even had a brief chat with him—to the benefit of others within earshot who were obviously listening—about the way the card worked as well as other ways to save on prescriptions (like visiting RXHope).

Had Scott not had the discount card and the pharmacy not offered its coupon, he would have had to pay the full $200 for the cream—in essence, meaning there was $100 that nobody would have known about that the insurance company was keeping. This shows that insurance companies aren’t passing down all the rebates to pharmacists—all the more reason to be an engaged consumer of healthcare.

Scott had a similar situation in which his wife went in to pick up a prescription for Estradiol, a hormone replacement patch. The brand name was $140, and the generic was $80. With the drug discount card, they were able to drop that price to $45—a substantial savings on any long-term medication.

What’s Next?

At the end of the day, you want to save money on prescriptions, right? Rebates go on in the pharma world to employers and insurance carriers all the time. How do you get your own rebate? The true examples above are here to show you that it is possible to get in on that game.

As we’ve illustrated, with certain specialty or single-sourced drugs, manufactures will deal directly with you in the form of PAPs (if you meet their requirements). With other, more generic drugs, a discount card might be the way to go. 

The bottom line? There is no downside to looking at your savings options—a little time could go a long way to the bank.  

How much could you be saving? Once you get your prescription costs down, tell a friend. Help them. The more we speak up as consumers of healthcare, the more premiums will come down, and the more we can be a part of changing this industry.

Let us know what you think!

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