Making Arthritis Drugs Accessible
Many people find that the arthritis drugs they have been
prescribed
are not accessible to them.
The
inaccessibility can be due to lack of insurance coverage,
low income, or denials from insurance companies.
Soaring prescription prices also compound the problem
of inaccessibility. But when access to prescription
drugs seems like a dead-end, there may still be other
avenues to try. In the May-June 2000 issue of 'Arthritis
Today', the official publication of the Arthritis
Foundation, some sound advice is offered which can
help bring necessary medications within reach. There
are particular do's and don'ts which can improve your
chances to obtain what you need.
The "Do" List
Be a savvy consumer
If you are a health insurance subscriber, learn exactly
what your plan covers. Familiarize yourself with the
schedule of benefits and know its limits. Determine
what medications are on the list of approved drugs,
called the formulary. If you have a choice of plans,
compare benefits and formularies. Remember also that
formularies can change, so be sure you are updated.
Be careful if you shop internationally
Many drugs can be obtained at significantly lower prices
outside the United States, in Canada and Mexico. When
considering the potential savings, remember that U.S.
law prohibits purchasing drugs which are not approved
by the FDA (Food and Drug Administration). Foreign
copies of approved American drugs are also prohibited.
There is no assurance that you will receive genuine
prescription drugs in foreign countries.
Ask your doctor for help
Seek the help of your doctor by asking him/her to write
a letter. Initial refusal by an insurance company to pay
for a prescription may possibly be reversed if your
doctor explains in a letter the absolute necessity of the
drug in your particular case.
Talk to your benefits director
If you have healthcare coverage through your employer,
view the benefits director as a supporter and someone
who can help you. The benefits director is often in a
position to influence the insurance company. Explain
your problem to the benefits director and enlist their
help. The benefits director may be your link to a
positive outcome.
Look into assistance programs
Pharmaceutical Assistance Programs are offered by
many drug companies for people in medical and financial
need. The requirements for qualification can vary
among the different drug companies but all call for an
application, a prescription, and a doctor's signature.
People considered for assistance programs are typically
uninsured with low income but some people qualify with
higher income.
Check the Drug Hotline list:
DRUG
|
PHONE NUMBER
|
WHAT'S AVAILABLE
|
Arava (leflunomide)
|
800-552-3656
|
Assistance Program Applications
|
Arthrotec
|
800-542-2526
|
Assistance
Program-Dr.Must
Call
|
Celebrex (celecoxib)
|
800-542-2526
|
Assistance
Program-Dr.Must
Call
|
Enbrel (etanercept)
|
800-282-7704
|
Waiting List For
Assistance
Program
|
Injectable
Methotrexate
|
800-321-4669
|
Assistance
Program
|
Methotrexate Tablets
|
800-568-9938
|
Assistance
Program-Dr.Must
Call
|
Naprosyn (naproxen)
|
800-526-6367
|
Assistance
Program
|
Plaquenil
(hydroxychloroquine)
|
800-446-6267
|
Assistance
Program
|
Prosorba
|
800-255-7277
|
Info About
Insurance &
Prosorba
|
Remicade
(infliximab)
|
800-964-8345
|
Assistance
Program
|
Vioxx (rofecoxib)
|
800-994-2111
|
Assistance
Program-Dr.Must
Call
|
If the drug you need is not on the list,
a guide is available
from the
Cost Containment Research Institute
in
Washington, D.C. to further help you.
If the drug you
need is on the list:
-
Call the drug manufacturer (in some cases your
doctor must make the call)
-
Inquire about their pharmaceutical assistance
program
-
Request an application
-
Once the application is received, fill it out and
have your doctor sign it
-
Your doctor must furnish a valid prescription
-
If your application is approved the drug is mailed
to your doctor's office
For a small to modest fee, there are organizations
which
can help with the paperwork.
The Medicine Program charges a $5 fee
for each drug and refunds the fee
if
the application is rejected.
Indigent Patient Services,
Inc. charges a
one-time $25 set-up fee plus $10 per
medication.
Shop for the best price
Compare prices to find the lowest cost
by calling your
local pharmacy or by
going in person to check their price
list.
Consider mail order options and
online pharmacies
when searching for the best price too.
Ask your doctor for samples
As a short term solution ask your doctor for free
samples. This is a particularly good idea
if you wish to
evaluate a new drug
prior to committing to it long term.
Remember though that samples are not available
for all
drugs, nor are they available
indefinitely.
Consider making your voice heard
Become an advocate and lobby for future change.
One
of the hottest issues for Election 2000
is Medicare
reform which would include a
prescription plan for the
elderly and disabled.
Stick with it
When considering what steps to take to help manage
your drug costs, persistence and patience
are essential.
All of the suggestions require
determination and effort,
but none are quick solutions.
The "Don't" List
Don't skip or reduce medications
It's bad news to skip or trim doses of medications
for the
purpose of budget-cutting.
This scheme may actually
backfire since your disease can progress
during the
times you don't take medications as scheduled.
The
eventuality may be a need for
more medications,
resulting in increased cost.
Don't hold your doctor responsible
Bear in mind that your doctor prescribes
the best drugs
available to treat your
specific case. Beyond that, your
doctor cannot
miraculously prevent difficulties which
you
may encounter in obtaining the drugs.
Work
together with your doctor
Try to find solutions which will
bring the drugs within your reach.
REFERENCE:
"Finding A Way - How To Handle Prescription Drug
Costs",
Arthritis Today magazine,
May-June 2000, by
Miranda Hitti.