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Bob Meade - Help paying for Rx

There is a continuum of services available to help those in need of prescription medicines. Most assistance programs measure individual or household income based on the Federal Poverty Level (FPL) guidelines. Income is the determining factor in whether or not assistance will be provided . . . specifically, income as a percentage of the Federal Poverty Level (FPL).
The individual poverty level for 2013 is $11,490. In multiple person households, add $4,020 for each additional person. For example, a family of four would have up to $23,550 in combined income and be considered at or below the poverty level. (http://aspe.hhs.gov/poverty/13poverty.cfm)
Virtually every drug company has what is called a Patient Assistance Program. The rules vary from company to company as most will allow income of 200 percent of the poverty level to qualify for free medicines, while some other drug companies allow up to 300 percent, and a few up to 400 percent of the FPL. Therefore, a family of four could have income at 200 percent of the poverty level ($47,100) and probably qualify for medicines from almost any pharmaceutical company. Qualifying income for a family of four at 300 percent would be $70,650, and at 400 percent $94,200. While these programs are not age dependent, some of the drug companies do require that those who are Medicare (Part D) eligible, first be denied "extra help" (low income support) from the Social Security Administration.
There is an excellent website — http://www.needymeds.org/ — that identifies drug companies, the medicines they manufacture, and the conditions each sets for providing patient assistance. Individuals who are Internet savvy, and who may be on a limited number of medicines, may access the Needy Meds website and get the information they need to manage their own applications. For most people, however, dealing with multiple drug companies, their differing requirements, and in some cases, differing ordering intervals, can get to be a bit confusing. Because of that, many people turn to programs like LRGHealthcare's Medication Connection Program, or the Medication Bridge Programs at other hospitals around the state.
The normal process for accessing one of these programs is for the Primary Care Provider (PCP) to refer the patient to the program at the medical facility to which he or she is associated, and to provide a copy of the patient's medication list. Once the referral is received, the program manager will send an application to the patient, along with a request for the financial and other information required by the drug companies who offer the medicines on the list the PCP has provided. When the program manager receives the information back from the patient, his or her experience can generally tell whether or not the patient meets the criteria specified by the drug companies involved. If it appears that they will accept the patient's application, the program manager obtains the necessary prescriptions from the PCP, arranges the information in the form and structure required by each of the involved drug companies, and sends it in to them. A patient's confidential file is then established and copies of all the pertinent information is retained. Upon approval from each involved company, the medicines for the patient are normally sent directly to the PCP's office, where the patient can pick them up. As most medicines are ordered in three month intervals, the PCP prescriptions usually call for a 90 day supply with three refills. The program manager establishes the re-order dates for each medicine, normally in a computerized file. The medicines are reordered at the appropriate time and, after the third refill is ordered, the re-application process is initiated. That process requires the patient to provide updated financial information to be sent to each of the involved companies.
There are a number of companies that offer drug discounts cards or coupons. Those who may have accessed the website for www.needymeds.org might have noticed a number of medicines that offered coupons. To view the entire list of coupons that are available that provide a discount, log into http://www.needymeds.org/coupons.taf?_function=list&letter=a. Needy meds also offers its own, free discount card that may be used, but there are a few restrictions, such as it can't be combined with insurance. For more detailed information log into http://www.needymeds.org/drugcard/index.htm .
A follow-on to this article will provide additional information on a number of addition resources that are available to help people receive their medicines. The article is planned to run on July 9.
(Bob Meade is a Laconia resident.)
 
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