The Medication Coverage You Need
The medication costs associated with transplantation can add up quickly, but financial barriers should not prevent you from receiving the medications intended for you by your doctor. Fortunately, there are a number of financial assistance options available.
Co-Pay Cards Provide Instant Savings
Co-pay cards provide a way to balance medication access with cost savings. Sometimes referred to as "point-of-sale" cards, co-pay cards can be presented at your retail, specialty, or mail-order pharmacy to reduce your out-of-pocket medication costs.
The Medication Co-Pay: Understanding Your Out-of-Pocket Costs
Most prescription drug plans have a formulary, a list of medications covered by that plan. Drugs on the formulary will be assigned to different levels of coverage, called tiers, which will in turn determine your co-pay amount:
Tier 1—lowest co-pay. Includes generic prescription drugs.
Tier 2—medium co-pay. Includes many brand name drugs, called preferred brands.
Tier 3—highest co-pay. Includes non-preferred generic and brand name drugs, which generally have lower-cost treatment options in tiers 1 and 2.
Tier 4—co-insurance. Includes specialty drugs, paid for as a percentage of the total drug cost.
(To learn more health insurance basics, be sure to download the "Understand Your Coverage" brochure under the Support section of http://www.transplantexperience.com/.)
There are many different kinds of co-pay cards available.3 In exploring your options, you may find that there's a tradeoff between the savings offered and the number of medications covered by the card. Non-profit organizations, like RxAssist, offer co-pay cards for a wide range of drugs, but often at low, fixed rates of savings.4 These are often redeemable in place of your private prescription coverage benefit, but can help offset high co-pays/deductibles, cover medications off-formulary, or assist you if you've already reached your plan's coverage maximum.5 Co-pay cards available through pharmaceutical companies, however, tend to offer higher savings rates specifically on their own brand name medications—sometimes on top of your prescription drug benefit.
Prescription Assistance Programs
You may also wish to consider prescription assistance programs (PAPs), which offer coverage or co-payment assistance to eligible individuals.7 Although PAPs are primarily known for subsidizing medication costs for uninsured or government-insured individuals, PAPs can also accommodate a wide range of privately insured individuals. Some PAPs, like HealthWell, will work with your private prescription insurance to supplement coverage for certain medical conditions.8 Others, like the Astellas Access Program, will cover the costs of Prograf and other Astellas medications for those financially eligible, regardless of the type of health insurance you have.
Since PAPs are numerous and wide-ranging, resources such as Partnership for Prescription Assistance, NeedyMeds, and RxAssist organize various PAPs by drug, medical condition, and region to help you build a list of programs that may be right for you. With eligibility requirements and medications covered by these PAPs constantly changing, you can always refer back to these sites periodically to reassess your options.
Be sure to discuss your findings with your transplant team—and, together, you can build a manageable financial plan for accessing the medications critical to your transplant health.
If you would like to learn more about Astellas Pharmaceuticals and the Transplant Experience, I encourage you to visit www.TransplantExperience.com to learn more. They provide a wealth of information for anyone looking at a life living with organ transplantation.
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