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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:

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.

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