The cost of prescription medications to treat your cancer may represent a significant portion of your medical expenses. Prescriptions may include oral chemotherapies, anti-nausea drugs and other medications. There are many resources to help pay for prescription medications. Here we will discuss two categories of potential help with affording your prescriptions:
- Prescription Insurance
- Patient Assistance Programs
Most health insurance policies include a prescription drug benefit. Often this benefit is managed for your insurance company by a different company. This means you have to call a different number when you have questions about your prescription coverage. The number to call should be on your insurance card. Just as you’ve done with your health insurance company, it’s a good idea to write down when you call, whom you speak with, and their phone extension.
Most likely, your insurance plan’s prescription drug coverage includes a formulary or a preferred drug list. The formulary includes most generic and some brand-name medications. On-formulary medications can usually be prescribed without any prior authorization. Every company has a different formulary, and the list changes often.
Prescription coverage can take several forms. Some plans will cover drugs that are on-formulary and not on-formulary, but you will generally have to pay more for non-formulary drugs. Other insurance plans may cover only on-formulary drugs and deny payment for all others without some sort of pre-approval process. The majority of formularies are tiered, or somewhere in between. As prescription medications have grown more expensive, the tiering has grown more complicated. Usually each tier has its own co-pay or co-insurance.
If your doctor prescribes a drug that isn’t on your health insurance plan’s formulary, you’ll usually discover this when you try to fill it at the pharmacy. Your pharmacist may call you or, when you go to pick up the prescription, the cost may be more than you expected. If this happens, first find out from your pharmacist if there is another medication on your insurance company’s formulary that is in the same class and does the same thing as the one prescribed.
If there is, you or your pharmacist can call your physician to ask their opinion about switching to the less expensive, on-formulary medication. Often the two medications are virtually the same. Your physician may feel that the on-formulary medication will be just as effective and be happy to change your prescription.
If your physician feels strongly that you should take a particular medication that is not on your formulary, most plans have a process through which a drug may be approved on a case-by-case basis. In these situations the company will generally require proof that you have already tried other medications and that they either failed you or you xperienced adverse effects from them. This is called step-therapy. If your coverage is still denied, an appeal process is usually available.
Patient Assistance Programs
If you do not have prescription medication coverage, have limited prescription insurance, or have a number of prescriptions, you may find you are having difficulty paying for all of them. In these instances, Patient Assistance Programs (PAPs) may be available to help. These are funded by state governments, charitable organizations, and pharmaceutical companies.
Nearly every pharmaceutical company has a Patient Assistance Program (PAP) for many of the medications that each particular company makes. These programs provide discounted or free medication to people who qualify. Some patient assistance programs will also facilitate an appeal process with your insurance company for coverage of particular medications. While there are financial criteria to qualify for most if not all of these programs, the criteria can be very generous. If you need help, it’s wise to apply. Click here for a list of PAP programs available
In addition to the programs provided by the drug companies, several non-profit organizations have developed programs to help patients with prescription costs including co-pays.