Help! I Can't Afford My Medication!
Have you ever struggled to pay for a prescription drug(s)?
According to a January (2015) publication from the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics, “Nearly 1 in 10 American adults don't take their medications as prescribed because they can't afford to.”1
Reasons for being unable to pay for medication may include:
- Insurance does not cover the prescribed medication leaving you to pay the full retail price out-of-pocket
- Not having insurance or having no prescription drug coverage
Whatever the reason, being unable to pay for your medication can cause undue stress and make optimizing diabetes control a real challenge. This is especially true, if you intentionally decrease the prescribed medication dose in an effort to lengthen your supply. As a result, you may be putting yourself at an increased risk for both acute and chronic complications.
This article will provide options that may help reduce the cost of your diabetes medication(s).
If you are insured by Medicare, consider adding prescription coverage. Prescription coverage is offered to everyone insured by Medicare.
If you do not meet eligibility criteria for Medicare, Medicaid may be another viable option.
According to Medicaid.gov, “……although pharmacy coverage is an optional benefit under federal Medicaid law, all States currently provide coverage for outpatient prescription drugs to all categorically eligible individuals and most other enrollees within their state Medicaid programs.” 2
If you are not currently insured by Medicaid and want to learn more about eligibility, please refer to following link.
Tips if not on government insurance
If you do not qualify for a government insurance program or already have commercial insurance, the following tips may help improve medication coverage and/or help reduce the cost of medication(s).3
- Learn what drugs are covered by your insurance. This information can be found on a drug formulary which is a list of prescription drugs covered by your insurance.
- Some medications require a prior authorization before being approved/covered. A prior authorization (PA): “… is a requirement that your physician obtain approval from your health insurance plan to prescribe a specific medication for you. PA is a technique for minimizing costs, wherein benefits are only paid if the medical care has been pre-approved by the insurance company.” 4
- If a prior authorization is denied (i.e. your medication is being denied coverage), you still have options:
- Ask your doctor if another drug can be prescribed (something that is either cheaper and/or on the drug formulary).
- File an appeal. You have the right to request an internal appeal in which a complete and fair review of the decision (denial) must be done.
- Request an external review. “If your insurance company denies the appeal, you are entitled under law to take the appeal to an independent third party for an ‘external review,’ which means the insurance company no longer gets final say for approval of a medication, treatment, or payment of a claim.”
- File a complaint. “If there are still problems after the external review process, you can file a complaint with the insurance commissioner or attorney general in your state.”
- Look into online and pharmaceutical resources
- Patient Assistance Programs. “Patient assistance programs (PAPs) are offered by most pharmaceutical companies and are designed to help those who have no health insurance, have poor insurance coverage for specific medications, or who otherwise cannot afford their medications.”
- Some other assistance programs that offer free and/or reduced cost drugs include:
- Partnership for Prescription Assistance
- Simple Fill
- Needy Meds
- Rebates and Coupons. Pharmaceutical companies often offer coupons and rebates. Rebates and coupons can be very helpful in reducing the cost of prescription drugs. Your doctor may also have rebate and coupon cards available at his/her office. If you don’t see them, just ask!
- Ask for Samples. If never hurts to ask your doctor if he/she has any medication samples. While a sample is only a temporary fix, it can help offset some of the expenses.
Were the financial costs of type 2 diabetes surprising to you?