In response to the excessive value of pharmaceuticals, “An Arm and a Leg” requested listeners to share their methods for getting the drugs they want at costs they will handle.
Host Dan Weissmann and producers Emily Pisacreta and Claire Davenport share ideas from a retired hospital supervisor who now helps seniors discover the fitting Medicare plans, a pharmaceutical gross sales rep, an worker advantages adviser, and a battle-worn hospital caseworker. Every brings shocking, perhaps even lifesaving, info to the desk.
Discover the complete crowdsourced collection, together with 5 installments of the “First Assist Package” e-newsletter: The Prescription Drug Playbook.
Dan Weissmann
Host and producer of “An Arm and a Leg.” Beforehand, Dan was a workers reporter for Market and Chicago’s WBEZ. His work additionally seems on All Issues Thought-about, Market, the BBC, 99 P.c 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
Notice: “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 instrument however examine 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 daily.
Jeanne Chamberlin: You might be like, oh my gosh. And actually the retail prices are $20,000 a month.
Dan: Jeanne’s an skilled, twice over. Since retiring from a profession managing hospitals and medical teams, she’s been serving to her fellow seniors work out how you can 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: Really 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.
In the course of the busy season — that’s within the fall, when folks can choose new insurance coverage for the approaching 12 months– Jeanne says she and her staff communicate to greater than 100 folks every week.
And one factor that comes up in principally ALL of these conversations: Can I alter issues to get my meds for much less subsequent 12 months?
She says one 12 months, 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 primarily based completely on the price of their medicine.
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 who wrote to us after we requested for you, our listeners, to inform us about your techniques and tips for coping with the excessive price of pharmaceuticals.
The outcome: two podcast episodes– that is quantity two — and 4 installments of our First Assist Package e-newsletter.
On this episode, we’re gonna hear from Jeanne and three different *unbelievable* sources who got here to us with essential insider information. Information that — now they we now have it– we now have 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 type 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 carry 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 differ. There isn’t a one resolution for everybody. It is a set of patches, workarounds, bandaids.
To be trustworthy, quite a lot of them are literally bizarre byproducts of the profit-making machine. Which is a giant cause they’re so patchy and unreliable.
We deserve SO significantly better. However within the meantime, we may help one another. That’s what this challenge 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 acquired you.
Our hope is that you simply stroll away from all of this armed with a *little* extra information that might provide help to or somebody you care about get the meds they want. A type 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 are able to perhaps 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 components 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 specialists should scramble typically.
Some time in the past, when Jeanne’s husband had a intestine an infection, he acquired 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 drawback fixing mode. And her order of operations gives a fantastic template for any of us.
The first step: Google for reductions. Simply taking a fast first cross on the type of factor we talked about in our final episode. Possibly that’s GoodRx. Possibly 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 understand you are able to do?
Dan: Jeanne was pondering: Possibly the doc might advocate one other antibiotic — one which insurance coverage would cowl. Or assist them struggle her husband’s insurance coverage to get this drug coated.
However really, 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 fantastic!
Dan: END OF STORY. On this case. It’s not at all times that straightforward. However the ethical is: ASK. In case your insurance coverage covers a distinct drug, your doc can inform you if it’s an excellent guess for you. If not… properly… we’ll come again to different methods your doc might assist.
However proper now let’s transfer on to the most important, most precious recommendation Jeanne offers to seniors– and that applies to everyone.
Particularly anyone with meds they’re taking long run, like blood strain or ldl cholesterol meds, or no matter.
And the recommendation is that this: Look forward, yearly.
Within the fall, when it’s time to enroll in subsequent 12 months’s insurance coverage plan: Get a take a look at the checklist of which medicine your insurance coverage will cowl, and the way a lot they anticipate you to pay for them. It’s referred to as the formulary.
As a result of even if you happen to 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 12 months’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 12 months, or final month in December, it was $30.
Dan: These of us didn’t plan to alter 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 most likely discovered a plan that coated that drug nonetheless..
Dan: Now, it’s true that folk on Medicare are likely 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 choose from.
In the event you get insurance coverage from work — and perhaps there’s only one plan — this factor of wanting forward is perhaps much more vital.
In some unspecified time in the future, perhaps a pair months earlier than the brand new 12 months, it is best to get an opportunity to see that subsequent 12 months’s formulary
And it might say, “Hey, your drug is gonna be costlier for you subsequent 12 months”
That’s your cue to begin problem-solving instantly. Get a plan in place earlier than that new value kicks in.
The first step: Verify: Can you discover reductions on-line that make this drug inexpensive? Cool.
No? Time to get in contact together with your supplier’s workplace: begin tapping their experience.
Jeanne: The supplier usually has lots of people together with your situation and possibly prescribes this remedy rather a lot.
Dan: And so, in case your insurance coverage firm says they’ve acquired another drug you could possibly take, one they’ll pay for– your supplier will know: might that drug be just right for you?
And if you happen to’ve acquired a alternative of plans — however all of them require a particular approval course of now to your drug — your supplier will know: Is one among them extra more likely to really problem that approval?
Jeanne: Ask them a few plan the place they’ve a straightforward time getting it authorised for someone together with your situation the place it at all times goes by.
Dan: And that’s the plan you wish 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’ll be able to’t plan every thing. Generally you get sick, with one thing new. No planning for that.
And typically, 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 score 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 adore it 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 quite a lot of wins.
Dan: We reached John in his major workplace — often known as his automobile.
After 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 ought to be considered as solutions.
Dan: Recommendations. Excellent. The opposite is way more particular. As a salesman, a giant a part of John’s job is prepping docs for the fights they’re gonna have with insurance coverage corporations, to get approvals for medicine. He does that as a result of approvals for them imply gross sales for John.
In fact, approvals take time.
John: However one factor that you understand 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 preventing for that approval– pushing again on the insurance coverage firm’s “suggestion” that you simply strive one thing else– Ask your supplier if they will 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: Really, your supplier could have already got some readily available. A examine 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 handle one thing huge: Like John joked about as we launched him, pharma gross sales reps are NOT typically seemed upon as mannequin residents.
The rap is: A few of them use less-than-scrupulous techniques to encourage docs to prescribe costly medicine… even to sufferers who won’t get additional profit from a selected drug. Or, within the case of opioids — which acquired pushed actually laborious — would possibly trigger hurt. And free samples are a part of that course of.
So, some suppliers gained’t meet with gross sales reps in any respect. Some well being methods don’t permit any of their workers to fulfill with them.
However you don’t should approve of how pharmaceutical corporations do their enterprise to make the most 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’ll 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 rather a lot. Dan: However quite a lot of these samples do exist —
And the concept of utilizing them as a stopgap whilst you struggle 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, to your ideas.
And also you additionally despatched us this: Might an area clinic provide the meds you want for a value you’ll be able to really 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 type of skilled 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 most likely 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 trainer places an outdated 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 staff. And– again to the shop-class metaphor — Cristy says she’s the actual 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 price.
Dan: Cristy says she does it by ditching costly, off-the-shelf components — customary insurance coverage insurance policies from huge corporations — for customized options. It’s a WHOLE THING, and super-interesting, and price going into.
For now, she’s acquired one huge 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’ll get medicine at extraordinarily low costs, by a federal program referred to as 340B.
How low?
Cristy Gupton: The drug Humira is likely one of the most prescription drugs in America. And the checklist 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 truly: Humira’s checklist 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 value 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 offer you my greatest, um, like solely know sufficient to be harmful reply.
Dan: After checking some precise specialists, right here’s what we predict you want to know:
A federal regulation from the Nineteen Nineties — part 340B of that regulation — principally requires drug-makers to present some hospitals and well being facilities that serve low-income of us super-duper reductions on meds.
These reductions don’t at all times 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 have to make medicine inexpensive to folks with decrease incomes. Particularly, to individuals who make lower than two occasions the federal poverty stage.
For 2025, that’s simply over 64 thousand {dollars} for a household of 4. Not rather a lot.
But it surely’s lots of people: Greater than 28 p.c of People qualify. And a few clinics could have sliding scales for folks with greater incomes than that.
So: There’s a search instrument. We’ve acquired a hyperlink wherever you’re listening to this. Discover a clinic in your space, name them, and see what the deal is.
One very last thing to know: You’ve gotta really be a affected person on the clinic in an effort to use this program. And truly, if you happen to meet the earnings necessities, all of the clinic’s companies are gonna be super-subidized.
However if you happen to don’t wish to interact too deeply with the clinic– don’t wish to change over all of your care to a brand new staff — Cristy says, in her expertise, you could not should.
Cristy Gupton: It may be as free as they only have a digital go to. I imply, that’s fairly easy.
Dan: Once more, we’ve acquired a hyperlink to the search instrument for locating a well being middle close to you. Which in fact…close to you… not everyone is gonna have. Your mileage could differ, actually. However is it value checking? Yeah, I feel so.
OK we’ve thrown a LOT at you. I do know, I do know. And we do have yet one more set of skilled ideas. From somebody we’re actually glad to have met. So right here’s Erika — and her experience is a part of a lifelong challenge.
Erika: You recognize, as a toddler with Kind one diabetes, I had a really dysfunctional family and I needed to deal with myself from a really younger age. I’ve realized that the talents that I developed as a toddler with a persistent 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 type of case employee, at a hospital in rural Oregon.
When my colleague Emily talked with Erika, they bonded a bit of.
Emily: I stay with Kind One Diabetes and I actually want that I had had a affected person navigator, um, after I was identified.
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 persistent situations and different critical well being issues, below robust circumstances.
Erika: For instance, let’s say a affected person has an amputation and so they’re instructed on discharge to maintain it elevated and preserve it clear. Properly in the event that they’re residing of their automobile, that may be a problem. So in that case, case administration would attempt to discover them a lodge for a pair weeks.
Dan: And naturally, one of the crucial widespread issues she tackles: serving to folks get their meds at costs they will 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 medicine their insurance coverage covers, at what value to them, and training them earlier than they name their insurance coverage firm.
Erika:I supply to be on the decision with them if they need. And I’ll inform you 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 fitting medicine 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 Packages” primarily based on earnings. 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 search out this type of factor — we’ve acquired hyperlinks and guides for you — and she or he says the purposes aren’t sophisticated.
However the folks she works with, they want additional assist.
Erika: A variety of my sufferers don’t even know how you can use a pc or to get onto the web, or they don’t have good telephones, they only have cell telephones. So quite a lot of them, I meet with them. I take my laptop computer, and we do an internet utility. I assist them fill it out.
Dan: After which hope it really works. Some packages solely give out a lot help per 12 months, so not everyone will get assist.
Erika: It’s a irritating struggle. I really feel unhealthy that individuals should wage this, you understand, to get what they should be wholesome. It’s, it’s not like persons are asking for BMW or new clothes. Individuals are asking for, oftentimes medicines they should preserve themselves alive. It’s, it’s like asking for oxygen. Like what if you happen to have been instructed you you couldn’t afford oxygen? That’s the best way folks really feel typically.
Dan: And that’s why, though Erika wrote to us about sensible specifics, it’s her method, her presence that we particularly needed to share with you.
Erika: I suggested all my sufferers to get a tattoo that claims, be persistent. I imply, critically, I don’t anticipate them to get tattoos. However as a affected person who manages a persistent situation, you simply should be.
Dan: Oh yeah. The continued burden of coping with all this, it’s a bear. And it got here up repeatedly whenever 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 respiration. And these are issues I educate to my sufferers a bit of bit too. Like, okay, let’s cease and do some respiration collectively on the cellphone. 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 respect that about your self. Okay? you’ve been on the cellphone together with your insurance coverage firm for half-hour.
You’re making an attempt to get this executed. You actually need to understand that you simply’re doing that to your well being. On your well being. Be ok with that, at the very least.
Dan: You’re taking 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 strive, which will or could not work — we’ve executed our greatest to write down them down for you, and manage them in order that they’re helpful, in our First Assist Package e-newsletter. 4 installments.
You’ll find these newsletters — and these episodes — at Arm and a Leg present, dot com, slash, medicine.
That’s the handle the place we first requested you to share what you’d realized by strolling by 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 medicine. 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 infinite and ridiculous course of that we typically should undergo to get our medicines… my colleague Claire Davenport, who has led the reporting for a lot of this collection, made an infinite and ridiculous track. Properly, with the assistance of an AI. Keep tuned after the credit for a bit of style of that.
We’ll be again with a brand new episode in a number of weeks.
Until subsequent time, deal with 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 Classes.
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 simply accept tax-exempt donations. You possibly can study extra about INN at INN.org.
Lastly, thanks to everyone who helps this present financially. You possibly can take part any time at Arm and a Leg present, dot com, slash: assist.
And NOW….a bit of deal with.
So: At one level, we have been like, “What if we might make like a jingle to assist folks keep in mind all of the techniques we’re speaking about?”
However when our producer Claire tried really writing one, with AI supplying the melody and the band — it simply kinda confirmed us how infinite and ridiculous the checklist really is.
And we discovered that simply cute. Right here’s the way it begins…
AI Music: I’m a prescription – remedy. And as you would possibly know, I’m Costly on this nation. Getting me will be complicated. And infrequently fairly scary. Since on the subject of meds. The costs can differ. Fortunately, there’s some tips you’ll be able to strive. Whenever you’re on this state of affairs and the worth is excessive…
Dan: Alright, I feel you get the concept — and if you need extra, it’s all at Arm and a Leg present dot com, slash, medicine. Together with these podcast episodes and First Assist Package e-newsletter installments, and every thing we hope you’ll really discover helpful. Thanks.
“An Arm and a Leg” is a co-production of KFF Well being Information and Public Highway Productions.
For extra from the staff at “An Arm and a Leg,” subscribe to its weekly e-newsletter, First Assist Package. You may also observe the present on Fb and the social platform X. And if you happen to’ve acquired tales to inform concerning the well being care system, the producers would love to listen to from you.
To listen to all KFF Well being Information podcasts, click on right here.
And subscribe to “An Arm and a Leg” on Spotify, Apple Podcasts, Pocket Casts, or wherever you hearken to podcasts.
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