Dr. Nabila Ismail, a Los Angeles-based pharmacist and content and engagement manager at GoodRx, explains that biologics are one of the most expensive medications in the market. “They’re called biologics because they are either made from living organisms or may contain components from them, making them more expensive for R&D and manufacturing,” On average, without insurance, Dr. Ismail explains that drugs can cost anywhere from $5,000-$20,000 per month. She adds that the enzyme inhibitors, which are psoriatic drugs that are new to the market, like Otezla, can cost a few thousand dollars a month as well. (The retail price for Otezla is 4,242.36/month!) The good news is there are many ways in which psoriatic arthritis patients can go about reducing the cost of their prescriptions. From enrolling in drug manufacturer financial assistance programs to buying in bulk, here are 13 tips on how to reduce your medication expenses.
How to save money on prescriptions
Start with your doctor
Rheumatologists are very familiar with how costly these medications can be and want you to have access to the treatment that you need, physically and financially. Therefore, they often have some tricks on their end for helping patients to find pathways to more affordable psoriatic arthritis medications. “It is really about being your own advocate, and definitely talking to your doctor first to see if they have somebody in the office that already has a relationship with a patient advocate that can help with discounts,” explains Rebecca Paone, a 38-year-old psoriatic arthritis patient in Clearwater, Florida. Dr. Ludmer agrees, noting that keeping your doctor in the loop when navigating the prescription process can be helpful. “Sometimes coupons may not be applied that patients could be eligible for. Sometimes we can help them with things,” she says.
Talk to your insurance company
Before deciding to start a medication, find out if your insurance covers the drug. Flip over your insurance card to the back and dial the 1-800 number. Speak to a customer representative and ask them to check your benefits. And be specific about how you will be taking this drug. Dr. Norman B. Gaylis, a rheumatologist in Aventura, Florida, says, “Some people prefer to have an infusion where it’s done for them, or some people prefer to inject themselves.” But, he adds, “Some insurances cover drugs that are given in the office and not drugs that you take at home.”
Contact the drug manufacturer to see if they offer an assistance program
A lot of the pharmaceutical companies behind psoriatic arthritis drugs have copay assistance programs where you can sign up for financial support. You can work with a social worker, pharmacist or customer care representative and they will get you signed up for a program and provide you with a discount card. Katie Roberts, a 45-year-old psoriatic arthritis patient in Annapolis, Maryland, for instance, is on a medication called Enbrel that costs around $12,000 per month. “Fortunately, my insurance covers a good part of that but my copay is $150 a month,” she says. The remainder of the cost is covered by a program called Enbrel Support, in which the drug manufacturer has copay assistance programs that patients can sign up for. “I have an Enbrel copay card and it works like a credit card,” says Roberts. “It has a certain amount of dollars allocated to that card annually so when I go to pay for my Enbrel, I use my copay assistance card and that covers the cost of my prescription,” she explains. So by using that card, she doesn’t have to pay out of pocket and the card covers her $150 copay. Paone says you can often find out who to contact is for financial assistance for a specific drug by Googling the name of the drug and going to its website. “You can usually apply for financial assistance online, or call their 1-800 phone number,” she says. “They usually have a call center that will walk you through the entire process.”
Buy in bulk
Stocking up on more than one month’s supply at a time can save you money in the long run. Roberts explains that she has seen Enbrel range from $5,000-$15,000 a month. Her copay is $150 but she has found a trick for not having to pay that 12 months a year: “My copay is $150 per prescription, whether it’s a one-month or three-month supply,” she explains. “By getting a 90-day supply, I reduce my copay costs. I pay $150 every three months—instead of $150 every month.”
Use a drug discount service like GoodRx
Roberts uses GoodRx for some of her pain management medications. “My insurance doesn’t cover medication below the copay so I will shop around for like $10 prescriptions or $12 prescriptions,” she explains. “And I’ll try to find out a lower-cost solution like GoodRx.” Roberts has used the service, or those similar, to purchase pain management medications like Voltaren. She’s also used it for Ibuprofen 800, which is an over-the-counter drug. “Sometimes if you get a prescription for it, it’s cheaper as a prescription than buying it over the counter,” she says. In addition to GoodRx, you can try services like Optum Perks, SingleCare, WellRx, RxSaver and Blink Health to shop for discounts on prescriptions.
Shop for tier-one prescriptions on your own
Roberts explains that her insurance company, like many, has a tiered prescription coverage policy—tier one, tier two and tier three and then specialty medications. Tier one medications, she explains, are usually the ones that fall under the copay. “If my copay is $25, Tier ones are usually under $25,” she explains. “So I reference that tiered prescription list. If it’s tier one, then I’ll likely go price shop for it, and see where I can get it the cheapest."
Consider alternative treatments
“The pathway to prescription is certainly necessary in many cases,” says Roberts. So if she’s looking for pain management, she may talk to her physician about the necessity of the prescription. And if there are alternative treatments, she might try those first. “For example, from a pain management perspective, I’ve done acupuncture or a massage, as my insurance covers both of those,” she says. “So sometimes, it is more economical for me to choose an alternative pain management treatment as opposed to a prescription drug.”
Ask your doctor if there is a different medication you can take
Paone was recommended Xeljanz by her doctor but her insurance informed her that it wouldn’t cover it. “It was almost 10 grand!” she proclaims. So in situations like that, she recommends talking to your doctor to see if there is another prescription that you can take that your insurance will cover. She’s currently on Taltz and she has a $0 copay for that one.
Make sure the drug is covered before you try a free sample
Doctor’s offices often have free samples of drugs to try out that they will give you to get started on. But before diving into a new protocol, even with a free supply, make sure that you reach out to your insurance company to see if it is going to be covered once the sample runs out. If your insurance won’t cover it, talk to your doctor about switching to another drug instead that might have a similar outcome.
Do your research before you switch insurance plans
Don’t switch insurance plans without making sure that your new plan will cover your existing medication. “One of the most important mistakes people make is not really researching their insurance plan well enough before they pick a plan,” says Dr. Ludmer. “I have seen many patients over the years that are on $50,000 a year drugs just up and change plans for the next year without any consideration of the fact that that drug might not be covered,” she shares. So do your research on that, because otherwise, Dr. Ludmer warns, you could end up very unhappy and there may be no way to undo it until the next calendar year.
Consider an insurance plan with a lower deductible
Last year, Meredith Amoroso, a 38-year-old psoriatic arthritis patient in Pittsburgh, found that her insurance company changed prescription insurance carriers. So now, her insurance no longer accepts her Enbrel copay card. “I had to pay $5,000 out of pocket for my first couple of doses, which was a huge blow,” she explains. “It’s one thing to have to pay over the course of a year, but I owed $5,000, because that was my deductible, on January 10. And I had to pay it right away to get the medication.” Now that she’s hit her deductible, she will have her prescription covered throughout the year but this made Amoroso realize that there is some power in choosing an insurance plan with a lower deductible.
Talk to your pharmacist
Next time you get in line to pick up your prescription, ask the cashier at the pharmacy if you can have a consult with the pharmacist. Dr. Ismail says he or she can offer advice on ways to save money and assist with things like insurance pre-authorizations. And she warns that it can take some time to get approval. “A prior authorization means that your insurance company requires supplemental information from your physician or provider to consider approving your medication,” she says, adding that your medication is important so patients should be proactive about refills to avoid any delays.
Speak up
Dr. Ludmer says that in this day and age, “being an arthritis advocate is really huge.” “There are a lot of bills right now going on in Congress that are significantly going to change reimbursement in a negative way for patients, including copay accumulators. And if you don’t know anything about that, that’s something you should learn about—being an advocate for the Arthritis Foundation, where you can use your voice and speak to members of Congress as these bills come up. You can let them know that, ‘Hey, I’m a real living person and I can’t afford my medications. I have to make choices between food and prescriptions or I haven’t been on vacation in 10 years because my drugs are costing me $50,000 a year,’” she explains. Next, Chloe in Curve gets honest about life with psoriatic arthritis and how to deal with flare-ups.
Sources:
Dr. Lynn Ludmer, a Baltimore-based rheumatologistDr. Nabila Ismail, a Los Angeles-based pharmacist and content and engagement manager at GoodRxRebecca Paone, a 38-year-old psoriatic arthritis patient in Clearwater, Florida.=Dr. Norman B. Gaylis, a rheumatologist in Aventura, FloridaKatie Roberts, a 45-year-old psoriatic arthritis patient in Annapolis, Maryland and an advocacy ambassador and chair & advocacy chair of Maryland’s local chapter of the Arthritis FoundationMeredith Amoroso, a 38-year-old psoriatic arthritis patient in Pittsburgh
