In response to the excessive value of prescribed drugs, “An Arm and a Leg” requested listeners to share their methods for getting the medication they want at costs they’ll handle.
Host Dan Weissmann and producers Emily Pisacreta and Claire Davenport share ideas from a retired hospital supervisor who now helps seniors discover the suitable Medicare plans, a pharmaceutical gross sales rep, an worker advantages adviser, and a battle-worn hospital caseworker. Every brings shocking, possibly even lifesaving, data to the desk.
Discover the total crowdsourced sequence, together with 5 installments of the “First Support Package” e-newsletter: The Prescription Drug Playbook.
Dan Weissmann
Host and producer of “An Arm and a Leg.” Beforehand, Dan was a employees reporter for Market and Chicago’s WBEZ. His work additionally seems on All Issues Thought-about, Market, the BBC, 99 % Invisible, and Reveal, from the Middle for Investigative Reporting.
Credit
Emily Pisacreta
Producer
Claire Davenport
Producer
Adam Raymonda
Audio wizard
Ellen Weiss
Editor
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Transcript: The Prescription Drug Playbook, Half II
Observe: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can include errors. Please use the transcript as a device however test the corresponding audio earlier than quoting the podcast.
Dan: Hey there. Let’s meet Jeanne Chamberlin from North Carolina. She commonly talks with of us who take like 15 totally different meds day by day.
Jeanne Chamberlin: You’re like, oh my gosh. And actually the retail prices are $20,000 a month.
Dan: Jeanne’s an professional, twice over. Since retiring from a profession managing hospitals and medical teams, she’s been serving to her fellow seniors work out learn how to handle what they pay for well being care — as a county-level volunteer coordinator for a program referred to as SHIP.
Jeanne: And SHIP stands for Seniors Well being Insurance coverage Data Program.
Dan: Truly in some circumstances it stands for State Well being Insurance coverage Help Program.
No matter you wanna name it — It’s a federally funded program that helps seniors with all issues Medicare. Each state has its personal model of SHIP.
Through the busy season — that’s within the fall, when folks can choose new insurance coverage for the approaching yr– Jeanne says she and her staff communicate to greater than 100 folks every week.
And one factor that comes up in mainly ALL of these conversations: Can I modify issues to get my meds for much less subsequent yr?
She says one yr, her staff added up the impression of these conversations. Half of the folks modified plans, and on common, they saved 300 {dollars}. Not unhealthy…
Jeanne: However there have been many, many individuals who saved a thousand, 2000, even $10,000 by altering from one Medicare plan to a different based mostly completely on the price of their medication.
Dan: Jeanne’s gonna inform us how she helps folks get these sorts of financial savings– with methods that aren’t only for folks on Medicare.
And Jeanne is only one one that wrote to us once we requested for you, our listeners, to inform us about your ways and methods for coping with the excessive price of prescribed drugs.
The end result: two podcast episodes– that is quantity two — and 4 installments of our First Support Package e-newsletter.
On this episode, we’re gonna hear from Jeanne and three different *unimaginable* sources who got here to us with essential insider information. Data that — now they we’ve got it– we’ve got to share with you.
Jeanne’s gonna assist us get arrange. She’s gonna share what she tells these seniors, and the way it can apply to anybody, at any age.
… Then, a pharma insider is gonna air an open secret.
An worker advantages advisor — a sort of scout for offers — will inform us the place she’d ship somebody struggling to pay for meds.
Lastly, we’ll meet a battle-worn hospital caseworker. And past the precise tip she wrote in with, her work – and life story – are gonna convey us some deeper perspective.
These folks kick ass.
And for all their recommendation, there’s, in fact, a BIG caveat:
like we mentioned final episode — your mileage will range. There isn’t a one resolution for everybody. This can be a set of patches, workarounds, bandaids.
To be sincere, plenty of them are literally bizarre byproducts of the profit-making machine. Which is an enormous cause they’re so patchy and unreliable.
We deserve SO a lot better. However within the meantime, we might help one another. That’s what this venture is about. Together with the 4 e-newsletter installments I discussed. And we’ll hyperlink to these from wherever you’re listening — so: you don’t want a pencil and paper right here. We’ve obtained you.
Our hope is that you just stroll away from all of this armed with a *little* extra information that would assist you to or somebody you care about get the meds they want. A sort of leg up. An Arm and a Leg-leg-up.
That is An Arm and a Leg, a present about why well being care prices so freaking a lot, and what we will possibly do about it. I’m Dan Weissmann– I’m a reporter, and I like a problem. So the job we’ve chosen on this present is to take one of many
most enraging, terrifying, miserable elements of American life, and produce you one thing entertaining, empowering, and helpful.
So, first: Jeanne wrote to us about what she is aware of from serving to folks enroll in Medicare. However she additionally had an instructive private story to share. As a result of even consultants should scramble generally.
Some time in the past, when Jeanne’s husband had a intestine an infection, he obtained prescribed two antibiotics. His insurance coverage protection meant one was gonna price him thirty bucks. However the different one? His plan didn’t cowl it And… .
Jeanne: It was $1,200. For a 14 day provide it was simply obscenely costly.
Dan: So instantly, Jeanne says she went into downside fixing mode. And her order of operations gives an excellent template for any of us.
The 1st step: Google for reductions. Simply taking a fast first move on the sort of factor we talked about in our final episode. Perhaps that’s GoodRx. Perhaps that’s a coupon from the drug maker. Outcomes for Jeanne: Not nice.
Jeanne: I might get it right down to $800. It’s like, nonetheless, you’re like $800. Actually?
Dan: So, on to step two: Inform your supplier there’s an issue and ask for recommendation.
Jeanne: We went again to the physician and mentioned, is there one thing else that you already know you are able to do?
Dan: Jeanne was pondering: Perhaps the doc might suggest one other antibiotic — one which insurance coverage would cowl. Or assist them combat her husband’s insurance coverage to get this drug coated.
However truly, the doc’s proposal was a lot less complicated.
Jeanne: She mentioned simply take the opposite one.
Dan: Simply take the one Jeanne’s husband might get for thirty bucks. Skip the second drug.
Jeanne: So he did, and he was positive!
Dan: END OF STORY. On this case. It’s not all the time that straightforward. However the ethical is: ASK. In case your insurance coverage covers a unique drug, your doc can let you know if it’s wager for you. If not… nicely… we’ll come again to different methods your doc might assist.
However proper now let’s transfer on to the most important, most useful recommendation Jeanne offers to seniors– and that applies to everyone.
Particularly anyone with meds they’re taking long run, like blood stress or ldl cholesterol meds, or no matter.
And the recommendation is that this: Look forward, yearly.
Within the fall, when it’s time to join subsequent yr’s insurance coverage plan: Get a take a look at the record of which medication your insurance coverage will cowl, and the way a lot they count on you to pay for them. It’s referred to as the formulary.
As a result of even should you don’t change something about your insurance coverage, your insurance coverage might change the formulary. That may occur to anyone.
Jeanne sees it on a regular basis with seniors, when their plans reboot at New Yr’s.
Jeanne: Folks are available in January and this occurs yearly, and say, I simply went to the pharmacy and. They need $300 for my drugs. And final yr, or final month in December, it was $30.
Dan: These of us didn’t plan to vary something about their insurance coverage — however their insurance coverage plan modified on them– and stopped masking a drug they’ve been taking. Now they’re getting charged sticker value.
And Jeanne’s like, ‘Man, I want you’d have come to see us in the course of the fall sign-up– open enrollment.’
Jeanne: We might have in all probability discovered a plan that coated that drug nonetheless..
Dan: Now, it’s true that folk on Medicare are inclined to have extra decisions than the remainder of us right here. In Medicare, drug protection is its personal separate plan — referred to as Half D — and seniors in Jeanne’s county have greater than a dozen to select from.
When you get insurance coverage from work — and possibly there’s only one plan — this factor of trying forward is possibly much more necessary.
In some unspecified time in the future, possibly a pair months earlier than the brand new yr, you need to get an opportunity to see that subsequent yr’s formulary
And it might say, “Hey, your drug is gonna be dearer for you subsequent yr”
That’s your cue to begin problem-solving instantly. Get a plan in place earlier than that new value kicks in.
The 1st step: Verify: Can you discover reductions on-line that make this drug inexpensive? Cool.
No? Time to get in contact along with your supplier’s workplace: begin tapping their experience.
Jeanne: The supplier usually has lots of people along with your situation and doubtless prescribes this remedy loads.
Dan: And so, in case your insurance coverage firm says they’ve obtained another drug you can take, one they’ll pay for– your supplier will know: might that drug be just right for you?
And should you’ve obtained a alternative of plans — however all of them require a particular approval course of now on your drug — your supplier will know: Is one in every of them extra prone to truly situation that approval?
Jeanne: Ask them a few plan the place they’ve a straightforward time getting it accepted for someone along with your situation the place it all the time goes via.
Dan: And that’s the plan you need to choose. And, talking of getting your insurance coverage firm’s approval:
We’re about to maneuver from Jeanne’s recommendation– plan forward, get your supplier to assist — to the subsequent step. As a result of you possibly can’t plan the whole lot. Generally you get sick, with one thing new. No planning for that.
And generally, your insurance coverage is certainly not gonna say sure instantly to the drug your doc thinks you want. And your doc thinks you want this specific drug. So, how ELSE can your supplier assist?
John: I work, uh — work for an business with an approval ranking under Congress.
Dan: He’s a pharmaceutical gross sales rep! He requested us to maintain his full title and employer confidential.
He’s additionally an Arm and a Leg fan.
John: I find it irresistible when, uh, I hear tales of common folks simply sticking it to the insurance coverage firm. It’s good when the affected person wins, trigger they don’t get plenty of wins.
Dan: We reached John in his major workplace — also called his automotive.
Once we requested listeners a number of months in the past to share classes about getting prescription meds with out paying an arm and a leg, he wrote proper in with ideas.
And one, I really like only for the perspective. Right here’s John studying from the e-mail he despatched us:
John: Step therapies. Uh, denials and value at pharmacy must be seen as solutions.
Dan: Strategies. Good. The opposite is way more particular. As a salesman, an enormous a part of John’s job is prepping docs for the fights they’re gonna have with insurance coverage firms, to get approvals for medication. He does that as a result of approvals for them imply gross sales for John.
After all, approvals take time.
John: However one factor that you already know doesn’t care about time is illnesses.
The illness of Crohn’s or Bipolar dysfunction, no matter, isn’t like, look, I’ll maintain off on affecting you till this prior authorization is completed.
Dan: So right here’s John’s recommendation: whilst you’re combating for that approval– pushing again on the insurance coverage firm’s “suggestion” that you just attempt one thing else– Ask your supplier if they’ll get free samples from the pharma firm — from a rep like him.
John: And the supplier hopefully will say, yeah, let me name the rep and we’ll go away some at entrance for you.
Dan: Truly, your supplier might have already got some readily available. A research from a number of years in the past discovered that TWO THIRDS of primary-care practices had CLOSETS of pharmaceutical samples. Which, wow.
So, let’s deal with one thing massive: Like John joked about as we launched him, pharma gross sales reps are NOT usually regarded upon as mannequin residents.
The rap is: A few of them use less-than-scrupulous ways to encourage docs to prescribe costly medication… even to sufferers who won’t get further profit from a particular drug. Or, within the case of opioids — which obtained pushed actually arduous — would possibly trigger hurt. And free samples are a part of that course of.
So, some suppliers received’t meet with gross sales reps in any respect. Some well being techniques don’t enable any of their employees to fulfill with them.
However you don’t should approve of how pharmaceutical firms do their enterprise to reap the benefits of John’s suggestion. And neither does your physician.
John says, to get free samples, your physician won’t even want to speak to anybody.
They will simply make a request on-line, on the producer’s web site. John says it undoubtedly occurs.
John: So even with suppliers or docs that I’ve by no means seen in my 9 years, I do know that they’ve gotten samples earlier than.
Dan: However right here too, there shall be limits.
John: Some producers don’t even do samples. So it actually varies loads. Dan: However plenty of these samples do exist —
And the thought of utilizing them as a stopgap whilst you combat to get your insurance coverage to pay for the meds you want — I had by no means considered it till we requested you, our listeners, on your ideas.
And also you additionally despatched us this: Might a neighborhood clinic provide the meds you want for a value you possibly can truly afford? That’s subsequent..
This episode of An Arm and a Leg is produced in partnership with KFF Well being Information. That’s a nonprofit newsroom masking well being points in America. Their journalists do superb work. We’re honored to be their colleagues.
OK, a complete new sort of professional right here. Like Jeanne, who we heard from earlier. Cristy Gupton additionally lives in North Carolina. She works as an impartial worker advantages designer. You’re in all probability like, what the hell is that? Right here’s how she describes her work.
Cristy Gupton: Think about you’re a child in highschool, in store class, and your instructor places an previous engine on the desk, and says, take it aside and put it again collectively once more and ensure it really works.
Dan: Besides, the machine is a well being profit program for employees. And– again to the shop-class metaphor — Cristy says she’s the true gear-head within the room .
Cristy Gupton: By the point I put the engine again collectively, it really works twice pretty much as good, however at half the fee.
Dan: Cristy says she does it by ditching costly, off-the-shelf elements — customary insurance coverage insurance policies from massive firms — for customized options. It’s a WHOLE THING, and super-interesting, and value going into.
For now, she’s obtained one massive tip that *some* of us might use to get entry to meds at super-low costs. Principally it’s this: Search for a neighborhood well being middle that provides a sliding scale. They will get medication at extraordinarily low costs, via a federal program referred to as 340B.
How low?
Cristy Gupton: The drug Humira is without doubt one of the most prescription drugs in America. And the record value might be someplace within the neighborhood of 5,000 a month. However a 340B coated entity might buy it for a penny.
Dan: So we checked, and really: Humira’s record value isn’t 5,000 {dollars}. It’s 7,000 {dollars}. However YES, a 340B clinic can get it for a penny. Now, they don’t get each drug that low-cost, however..
And look: though that is all very a lot price realizing about, it’s not assured to be just right for you.
340B is sophisticated in all types of the way. Right here’s my colleague Emily Pisacreta asking Christy about it.
Emily: Assist me perceive what 340B is.
Cristy Gupton: I’ll provide you with my greatest, um, like solely know sufficient to be harmful reply.
Dan: After checking some precise consultants, right here’s what we expect you should know:
A federal regulation from the Nineties — part 340B of that regulation — mainly requires drug-makers to offer some hospitals and well being facilities that serve low-income of us super-duper reductions on meds.
These reductions don’t all the time get handed alongside to sufferers. The feds say hospitals and clinics can take a revenue, to subsidize their different work .
However the guidelines say: neighborhood well being facilities DO must make medication inexpensive to folks with decrease incomes. Particularly, to individuals who make lower than two instances the federal poverty stage.
For 2025, that’s simply over 64 thousand {dollars} for a household of 4. Not loads.
But it surely’s lots of people: Greater than 28 % of People qualify. And a few clinics might have sliding scales for folks with increased incomes than that.
So: There’s a search device. We’ve obtained a hyperlink wherever you’re listening to this. Discover a clinic in your space, name them, and see what the deal is.
One final thing to know: You’ve gotta truly be a affected person on the clinic with a view to use this program. And truly, should you meet the revenue necessities, all of the clinic’s providers are gonna be super-subidized.
However should you don’t need to have interaction too deeply with the clinic– don’t need to change over all of your care to a brand new staff — Cristy says, in her expertise, chances are you’ll not should.
Cristy Gupton: It may be as free as they simply have a digital go to. I imply, that’s fairly easy.
Dan: Once more, we’ve obtained a hyperlink to the search device for locating a well being middle close to you. Which in fact…close to you… not everyone is gonna have. Your mileage might range, actually. However is it price checking? Yeah, I believe so.
OK we’ve thrown a LOT at you. I do know, I do know. And we do have yet one more set of professional ideas. From somebody we’re actually glad to have met. So right here’s Erika — and her experience is a part of a lifelong venture.
Erika: , as a toddler with Kind one diabetes, I had a really dysfunctional family and I needed to care for myself from a really younger age. I’ve realized that the abilities that I developed as a toddler with a power sickness are transferable right into a profession to assist folks be taken care of.
Dan: So now, she works as a affected person navigator– a sort of case employee, at a hospital in rural Oregon.
When my colleague Emily talked with Erika, they bonded a bit.
Emily: I stay with Kind One Diabetes and I actually want that I had had a affected person navigator, um, once I was recognized.
Erika: Yeah, I want I had me as a affected person navigator too.
Dan: A lot of the sufferers Erika does work with are managing power circumstances and different critical well being issues, below powerful circumstances.
Erika: For instance, let’s say a affected person has an amputation and so they’re informed on discharge to maintain it elevated and preserve it clear. Properly in the event that they’re dwelling of their automotive, that may be a problem. So in that case, case administration would attempt to discover them a resort for a pair weeks.
Dan: And naturally, some of the widespread issues she tackles: serving to folks get their meds at costs they’ll afford.
Erika: There are weeks the place that’s all I’ll do.
Dan: For insured sufferers, Erika he begins with drugs-and-insurance 101: Serving to them work out which medication their insurance coverage covers, at what value to them, and training them earlier than they name their insurance coverage firm.
Erika:I provide to be on the decision with them if they need. And I’ll let you know proper now that we’re gonna be on maintain with that insurance coverage firm for half-hour
Dan: Yeah, that sounds acquainted. Additionally, for some sufferers on Medicaid, Erika runs interference with bureaucracies.
And, when there’s no means that insurance coverage will make the suitable medication inexpensive for her sufferers– together with of us with no insurance coverage in any respect– Erika helps them discover one of many choices she wrote in to us about.
“Affected person Help Applications” based mostly on revenue. Some are from producers, others come from non-public foundations.
Erika: It’s such a matter of someone realizing who to ask and the place to get the stuff.
Dan: And there are web sites to seek out this sort of factor — we’ve obtained hyperlinks and guides for you — and he or she says the purposes aren’t sophisticated.
However the folks she works with, they want further assist.
Erika: Numerous my sufferers don’t even know learn how to use a pc or to get onto the web, or they don’t have good telephones, they simply have cell telephones. So plenty of them, I meet with them. I take my laptop computer, and we do a web-based utility. I assist them fill it out.
Dan: After which hope it really works. Some applications solely give out a lot help per yr, so not everyone will get assist.
Erika: It’s a irritating combat. I really feel unhealthy that individuals should wage this, you already know, to get what they have to be wholesome. It’s, it’s not like individuals are asking for BMW or new clothes. Individuals are asking for, oftentimes drugs they should preserve themselves alive. It’s, it’s like asking for oxygen. Like what should you had been informed you you couldn’t afford oxygen? That’s the best way folks really feel generally.
Dan: And that’s why, despite the fact that Erika wrote to us about sensible specifics, it’s her method, her presence that we particularly wished to share with you.
Erika: I suggested all my sufferers to get a tattoo that claims, be persistent. I imply, severely, I don’t count on them to get tattoos. However as a affected person who manages a power situation, you simply should be.
Dan: Oh yeah. The continuing burden of coping with all this, it’s a bear. And it got here up many times while you wrote in to us.
Erika: Yeah. Stress administration, whew.
Dan: For Erika’s sufferers, and for herself too.
Erika: I’ve to recollect to love, cease, step away, do some respiratory. And these are issues I educate to my sufferers a bit bit too. Like, okay, let’s cease and do some respiratory collectively on the telephone. Okay.
Dan: She calls her technique “self compassion.” It’s about serving to folks see how a lot they’re already doing.
Erika: I encourage folks to take a second and recognize that about your self. Okay? you’ve been on the telephone along with your insurance coverage firm for half-hour.
You’re making an attempt to get this completed. You actually need to understand that you just’re doing that on your well being. On your well being. Be ok with that, at the very least.
Dan: You take time to hearken to this podcast. We’re right here, proper now, collectively, doing our greatest.
For the sensible classes — all of the issues to attempt, which will or might not work — we’ve completed our greatest to put in writing them down for you, and manage them in order that they’re helpful, in our First Support Package e-newsletter. 4 installments.
You could find these newsletters — and these episodes — at Arm and a Leg present, dot com, slash, medication.
That’s the deal with the place we first requested you to share what you’d realized by strolling via this maze. Now we’re inviting you to return and see what we’ve realized from you.
Arm and a Leg present dot com, slash medication. There’ll be a hyperlink wherever you’re listening to this.
And also you’ll discover yet one more factor there, too.
To honor the countless and ridiculous course of that we generally should undergo to get our medicines… my colleague Claire Davenport, who has led the reporting for a lot of this sequence, made an countless and ridiculous track. Properly, with the assistance of an AI. Keep tuned after the credit for a bit style of that.
We’ll be again with a brand new episode in a number of weeks.
Until subsequent time, care for your self.
This episode of An Arm and a Leg was produced by Emily Pisacreta and Claire Davenport with assist from me, Dan Weissmann, and Lauren Gould.
And edited by Ellen Weiss.
Adam Raymonda is our audio wizard.
Our music is by Dave Weiner and Blue Dot Periods.
Bea Bosco is our consulting director of operations.
Lynne Johnson is our operations supervisor.
An Arm and a Leg is produced in partnership with KFF Well being Information. That’s a nationwide newsroom producing in-depth journalism about well being points in America — and a core program at KFF: an impartial supply of well being coverage analysis, polling, and journalism.
Zach Dyer is senior audio producer at KFF Well being Information. He’s the editorial liaison to this present.
An Arm and a Leg is Distributed by KUOW — Seattle’s NPR station. And due to the Institute for Nonprofit Information for serving as our fiscal sponsor.
They permit us to just accept tax-exempt donations. You’ll be able to study extra about INN at INN.org.
Lastly, thanks to everyone who helps this present financially. You’ll be able to take part any time at Arm and a Leg present, dot com, slash: help.
And NOW….a bit deal with.
So: At one level, we had been like, “What if we might make like a jingle to assist folks bear in mind all of the ways we’re speaking about?”
However when our producer Claire tried truly writing one, with AI supplying the melody and the band — it simply kinda confirmed us how countless and ridiculous the record truly is.
And we discovered that simply lovely. Right here’s the way it begins…
AI Tune: I’m a prescription – remedy. And as you would possibly know, I’m Costly on this nation. Getting me could be complicated. And infrequently fairly scary. Since in terms of meds. The costs can range. Fortunately, there’s some methods you possibly can attempt. Once you’re on this state of affairs and the value is excessive…
Dan: Alright, I believe you get the thought — and if you would like extra, it’s all at Arm and a Leg present dot com, slash, medication. Together with these podcast episodes and First Support Package e-newsletter installments, and the whole lot we hope you’ll truly discover helpful. Thanks.
“An Arm and a Leg” is a co-production of KFF Well being Information and Public Street Productions.
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