July 27, 2020 Ashley Struble

Making Medications More Affordable

From a Specialty Pharmacy Liaison – A patient who receives her medication through the hospital specialty pharmacy and also gets a monthly infusion as part of her therapy called concerned about the bills she was getting from the hospital. It showed her infusion medication was over $5,000 each month, with her expected payment varying between $150-$280. She reached out to me for help but wasn’t sure if we could help because the hospital specialty pharmacy is limited to oral medication assistance. She felt her options for seeking help were limited but she was comfortable talking to me because we have talked so often.

We scheduled a time to meet in the office and go over each bill received since she started in November. After sorting through everything, it looked as though she was getting a ‘discount,’ but she said she was beginning to struggle a little bit with payments each month. I explained I would look into assistance programs for the infusion medication and have the financial assistance sent directly to the hospital from the drug manufacturer.

We went over the paperwork and the expected timeline for everything to be resolved. After about 45 minutes of sitting with the patient and helping her understand how her medications are being billed (the differences between her Medicare B medications and Medicare D medications), she felt more at ease.

I filled out the paperwork for the financial assistance and faxed it to the drug manufacturer immediately to start that process as soon as possible. The patient left saying our conversation felt more like she was talking to a family member about a genuine concern and not just someone at a mail-order pharmacy saying they’ll look into it. I’m proud to say she is doing well and her financial concerns are no longer a barrier to her care and treatment.