A dozen years ago, when I had no prescription drug insurance and was juggling multiple medical issues, I used to leave my doctor’s office with a grocery bag full of free pharmaceutical company samples. She supplied all of my medications this way, except for one essential drug that she couldn’t get from a pharma rep. It cost a quarter of my monthly income, and I sometimes had to skip a few days until I had the money to pick up a refill.
Today, many more options exist for people struggling with the high cost of prescription drugs. At Burlington’s Community Health Center, patient assistance specialist April Werner helps the busy medical practice’s clients sort through those options. Although she works directly only with CHC patients, she offers a wealth of helpful suggestions for all Vermonters worried about paying for pricey pills.
The initial step for those who find themselves having trouble affording their medications? “First of all, they should take a look at their health insurance situation as a whole,” Werner advises. “We’re lucky that we live in Vermont, and Vermont provides programs for people with limited incomes that other states don’t provide.” To see if you qualify for benefits ranging from Medicaid to Catamount Health, contact Vermont’s Green Mountain Care.
Some 65,000 Vermonters remain among the 47 million uninsured Americans, according to the Green Mountain Care website. In recent years, pharmaceutical companies have begun providing free medications to patients who cannot afford them. Those cheery TV ads with Montel Williams and the orange-and-white bus? They’re for the Partnership for Prescription Assistance, which links hundreds of programs that 48 drug companies currently sponsor.
Each medication requires a separate application, and each program has slightly different rules, which may seem daunting. But Werner helps CHC patients apply, and she praises the process and the results. “It’s not a lot of paperwork,” she explains. “It’s usually a one-page application, which is very straightforward.” Applicants must also provide documentation of income and a doctor’s prescription. “If you qualify, it’s a great thing,” Werner says.
Some patients with insurance may be eligible, as are others who might not seem to fit the criteria at first glance. Drug companies use discretionary “hardship waivers,” Werner notes. “They will consider your situation even if you don’t fit the simplest way of interpreting what their requirements are.” And income limits are much more generous than are those of state programs such as Medicaid. “So you could be a working person, and even work full time, but your income may still qualify you for these programs,” she adds.
You may not have to jump through any of these hoops, however, if the meds you need are basic generics. Hannaford, Wal-Mart and the new Community Health Pharmacy each have hundreds of drugs available cheaply.
Hannaford’s list is the most extensive, with more than 450 drugs in their “Healthy Saver” program, which charges a $7 annual membership fee. A 30-day supply (of a “commonly prescribed dosage”) costs $4; 90 days, $9.99. Several simple antibiotics (up to a 14-day supply) are free.
Wal-Mart pioneered the concept of a bargain formulary just over two years ago. Today, it offers about 350 meds at $4 for a 30-day supply and $10 for a 90-day supply. The retail giant also touts recent price breaks for its over-the-counter brand Equate, which includes more than 1000 OTC meds priced under $4 for 30 days’ worth. Both Hannaford and Wal-Mart also offer select prescription meds for women, such as tamoxifen, at $9-10 a month.
Inexpensive generics have been a boon even to well-insured patients, who have seen pharmacy co-pays skyrocket. “It really pays for you to check into it,” notes Werner, who has taken advantage of them herself. “Even if you have very good health insurance, there are some things that may be cheaper than your co-pay to get from their generic list.”
Clients of Vermont’s five federally funded health centers and their affiliated clinics — the CHC in Burlington, Alburgh Health Center, the Health Center of Plainfield, Community Health Services of the Lamoille Valley and Northern Counties Health Care — can also take advantage of the new Community Health Pharmacy in Colchester. It offers all the drugs on the Wal-Mart formulary, with $4/8/10 pricing for 30/60/90-day supplies.
But CHP also offers many other medications at a fraction of their retail prices, because its affiliation with the health centers allows it to purchase meds at extremely low wholesale prices. For patients living outside of the Champlain Valley, the pharmacy mails prescriptions at no extra charge.
Even with all of these alternatives, are there still Vermonters feeling squeezed by exorbitant prescription prices? “Yes, of course,” Werner readily admits. “They don’t realize that they have an option. Even worse — and more common, probably — is the person who just chooses not to take what they need for good health. Because the only thing they know is that their drugstore says it costs $140 a month to take something. And that’s really kind of tragic.”