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Access to Innovative Medicines May be Just a Click Away

Approved Rejected Denied - Prior AuthorizationWhen prescribing a new medication for a patient, especially if it is new to market, it is important to have the conversation with the patient and their family or caregivers about the potential cost. A medication may be approved and covered by a patient’s insurance, however the co-pay can still be too costly. There are a variety of assistance programs available to help patients find the least expensive option at local pharmacies,  provide coupons that assist with co-pays or even cover the entire cost of the medication. Knowing what options are available and reviewing them with patients can improve both the patient experience and increase adherence to these important medications.

Various online programs are available to help patients compare the best possible prescriptions prices for every FDA-approved prescription drug. GoodRX  (www.goodrx.com) is an app and website that allows patients to at more than 70,000 pharmacies.  It even has free coupons for some drugs to be used at the pharmacy. If a patient has insurance or Medicare, GoodRx can help them find prices that are lower than the typical co-pay. Since the coupons cannot be used with insurance or to lower the copay, the patient would use the GoodRx discount instead of their prescription insurance if the cost is lower. Other options include LowestMed (www.lowestmed.com), OneRX (www.onerx.com), and BlinkHealth (www.blinkhealth.com).

Some programs are available to assist with prescription costs for specific disease states. One example is the Patient Access Network (PAN) foundation (panfoundation.org) which helps underinsured people with a variety of life-threatening, chronic and rare diseases through funding by donors and collaboration with providers and pharmacies. The conditions which are covered vary over time, so before encouraging patients to apply for coverage, make sure you check the website. Another organization is the Patient Advocate Foundation, which provides tips and other websites, such as www.rxoutreach.com, that can help patients get funding support.  

You can also review options with a pharmaceutical representative or on the drug manufacturer website.  When pharmaceutical companies come out with new medications and until they go off patent, they often offer 30 days of free medication and copay reduction cards. Many pharmaceutical companies have established their own patient assistance programs to help patients access needed therapies at reduced cost. Unfortunately, patients enrolled in state or federally funded insurance programs (e.g. Medicare, Medicaid, VA) are not eligible for the copay reduction cards and 30 days of samples.

Patients and families are asking more frequently about options that can help them cover their health care costs, yet often providers aren’t aware of the financial support available through a variety of programs that can be found with a little research. Cardiovascular nurses can help patients access needed medications; because ultimately, nurses want to be able to answer questions and provide their patients with the right medications at the right cost for them. 

Thank you to program sponsors for PCNA's Access to Innovative Medicines campaign: Amgen, Inc