Guide for Helping Patients Afford Their Medications

Full Update October 2021

Improving adherence has the potential to save billions of healthcare dollars. However, the inability to afford medications is a known adherence barrier. This chart includes cost-saving tips and a list of programs and resources to consider for patients. Note: list may not be all-inclusive.

Cost-Saving Tips

Try to streamline 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.

Consider tablet splitting

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

Review quantities

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.

Consider a limited role for drug samples and co-pay coupons

Drug samples and co-pay coupons can save money upfront, but can cost patients more in the long run.

  • Patients get stabilized on these meds, which are often more expensive.
  • Co-pay coupons:
    • True drug co-pays may not be realized until the coupon expires or the max amount covered by the coupon is reached.
    • Can’t be used by patients with government-funded drug coverage (e.g., Medicare, Medicaid, TRICARE).
  • Save samples and coupons for meds that don’t have more affordable alternatives, or for short-term meds such as antibiotics.

Consider a limited role for discount or savings cards

Discount or savings cards are typically used as an alternative to insurance, although requirements for eligibility can vary.

  • Money spent on Rxs using these may not be applied to the patient’s deductible.
  • Rxs not run through insurance may skew quality measures.
  • Encourage patients to ask if their pharmacy has its own discount program.

Look for assistance programs

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, help patients pay for 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.

Web-based Resources for Savings on Medications

Information Source

Comments

Amazon Prime Rx

www.amazon.com/primerx

Site allows drug price comparisons between pharmacies, including Amazon’s pharmacy. Medications can be filled at a local pharmacy using their Rx savings card or mailed directly to the patient from Amazon. Access to this is included in an Amazon Prime membership.

American Diabetes Association

www.diabetes.org

Site provides a list of several discount programs and diabetes-specific patient assistance programs at: https://insulinhelp.org/.

Asthma and Allergy Foundation of America

www.aafa.org

Site provides a list of several discount programs and respiratory-specific patient assistance programs at: https://www.aafa.org/patient-assistance-medicine-drug-programs.

Blink Health

www.blinkhealth.com

844-265-6444

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.singlecare.com/familywize#fw

844-234-3057

FamilyWize has teamed up with SingleCare (see below).

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.

HelpRx

www.helprx.info

Can search for prescription coupons on the website by medication name or medical condition for use at local pharmacies.

HIV Medicine Association

www.hivma.org

Site provides a list of several discount programs and HIV-specific patient assistance programs at: https://www.hivma.org/hivaids-resources/patient-assistance-programs/.

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. 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 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

571-350-8643

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).

NeedyMeds

www.needymeds.org

800-503-6897

Can search for assistance by brand or generic medication name, assistance program name, or medication manufacturer. May have discounts for medical supplies (e.g., glucose test strips). Information about Medicaid, Medicare, and other state assistance programs is available. Includes a free drug discount card that can be ordered by mail or downloaded and printed. Has a free app for iPhone or Android that has this functionality.

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.

RxSaver

www.rxsaver.com

Can search for prescription coupons on the website or free iPhone or Android app to use at local pharmacies.

SingleCare

www.singlecare.com

844-234-3057

Site allows drug price comparisons between pharmacies for a specific drug. Coupon cards can be downloaded, texted, or emailed to use at participating pharmacies. Has a free app for iPhone or Android that has this functionality in addition to access to drug coupons. Patients can subscribe to the savings newsletter.

Together Rx Access

www.togetherrxacces.com

800-444-4106

Can search for medications by brand or generic name. Medications are mailed directly to the patient.

WellRx

www.wellrx.com

Can search and compare medication prices at local pharmacies. Savings cards can be texted, printed, emailed, or downloaded. Also has drug and health condition information. Has a free app for iPhone or Android that has this functionality.

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.

800-292-6363

or

www.azandmeapp.com

Many AstraZeneca prescription medications

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

Good Days

Individuals with qualifying incomes, insurance coverage, diagnosed with a covered disease, and taking a medication that is FDA-approved for the diagnosis.

877-968-7233

or

www.mygooddays.org

Many prescription medications for covered conditions

Assistance may include copay, travel, insurance premium, or diagnostic testing assistance.

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 medications 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.

Oncology products:

844-447-5662

Benlysta

877-423-6597

Nucala

844-468-2252

Other products

866-728-4368

www.gskforyou.com

Many GSK prescription medications

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

Janssen CarePath

(Janssen)

Allows healthcare professionals to:

  • investigate benefits and prior authorizations
  • enroll patients in savings programs
  • view product-specific affordability options
  • view savings programs transactions

877-227-3728

or

www.janssencarepath.com

Many Janssen prescription medications

Assistance may include state pharmaceutical assistance programs, drug discount cards, or support through independent charitable organizations.

Lilly Cares

(Eli Lilly)

Individuals with qualifying incomes who:

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

Must call Lilly Cares to review requirements for patients needing assistance with Humatrope.

800-545-6962

or

www.lillycares.com

Many Lilly prescription medications

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 medications

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 medications

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 for the medication being taken who meet income requirements.

866-316-7263

or

https://www.panfoundation.org/index.php/en/

A list of medications to treat specific conditions

Assistance with insurance premiums, deductibles, co-pays, coinsurance, and transportation expenses to get to treatment.

Pfizer Rx Pathways

(Pfizer)

Eligibility requirements vary by medication and type of assistance provided.

866-706-2400

or

www.pfizerrxpathways.com

Many Pfizer prescription medications

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

The Assistance Fund

Individuals with qualifying incomes, diagnosed with a covered disease may qualify. Eligibility may vary by medication and type of assistance provided.

855-845-3663

or

tafcares.org/

Many prescription medications for covered conditions

Assistance with copays, healthcare expenses, health insurance premiums, and other medical expenses.

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 drugs prices through mail order pharmacies.

Cite this document as follows: Clinical Resource, Guide for Helping Patients Afford Their Medications. Pharmacist’s Letter/Prescriber’s Letter. October 2021. [371007]

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