In response to the excessive worth of prescribed drugs, “An Arm and a Leg” requested listeners to share their methods for getting the medication they want at costs they will handle.
Host Dan Weissmann and producers Emily Pisacreta and Claire Davenport share suggestions from a retired hospital supervisor who now helps seniors discover the appropriate Medicare plans, a pharmaceutical gross sales rep, an worker advantages adviser, and a battle-worn hospital caseworker. Every brings shocking, perhaps even lifesaving, data to the desk.
Discover the total crowdsourced collection, together with 5 installments of the “First Assist Package” publication: 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 Heart 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
Be aware: “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 test the corresponding audio earlier than quoting the podcast.
Dan: Hey there. Let’s meet Jeanne Chamberlin from North Carolina. She recurrently talks with people who take like 15 completely different meds day by day.
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 determine how you can handle what they pay for well being care — as a county-level volunteer coordinator for a program known as SHIP.
Jeanne: And SHIP stands for Seniors Well being Insurance coverage Data Program.
Dan: Really in some instances 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.
Throughout 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 crew converse to greater than 100 folks every week.
And one factor that comes up in mainly ALL of these conversations: Can I alter issues to get my meds for much less subsequent 12 months?
She says one 12 months, her crew 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 fully 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 techniques and tips for coping with the excessive value of prescribed drugs.
The outcome: two podcast episodes– that is quantity two — and 4 installments of our First Assist Package publication.
On this episode, we’re gonna hear from Jeanne and three different *unbelievable* sources who got here to us with essential insider data. 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 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, after all, a BIG caveat:
like we mentioned final episode — your mileage will range. There is no such thing as a one resolution for everybody. It is a set of patches, workarounds, bandaids.
To be trustworthy, lots of them are literally bizarre byproducts of the profit-making machine. Which is an enormous motive they’re so patchy and unreliable.
We deserve SO a lot better. However within the meantime, we will help one another. That’s what this mission is about. Together with the 4 publication 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 bought you.
Our hope is that you simply stroll away from all of this armed with a *little* extra data that would make it easier 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 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 elements of American life, and convey 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 bought prescribed two antibiotics. His insurance coverage protection meant one was gonna value 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 offers a fantastic template for any of us.
The first step: Google for reductions. Simply taking a fast first go on the sort 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 are able to do?
Dan: Jeanne was considering: Possibly the doc might suggest one other antibiotic — one which insurance coverage would cowl. Or assist them battle her husband’s insurance coverage to get this drug coated.
However truly, the doc’s proposal was a lot easier.
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 advantageous!
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 special drug, your doc can let you know if it’s a superb 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 all people.
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 have 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 known 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 Yr’s.
Jeanne: Individuals are available in January and this occurs yearly, and say, I simply went to the pharmacy and. They need $300 for my medication. And final 12 months, or final month in December, it was $30.
Dan: These people didn’t plan to vary something about their insurance coverage — however their insurance coverage plan modified on them– and stopped protecting a drug they’ve been taking. Now they’re getting charged sticker worth.
And Jeanne’s like, ‘Man, I want you’d have come to see us throughout 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 selections than the remainder of us right here. In Medicare, drug protection is its personal separate plan — known 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.
Sooner or later, 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 start out problem-solving straight away. Get a plan in place earlier than that new worth 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 doubtless prescribes this remedy so much.
Dan: And so, in case your insurance coverage firm says they’ve bought another drug you might take, one they’ll pay for– your supplier will know: might that drug be just right for you?
And if you happen to’ve bought a selection 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 prone to truly problem that approval?
Jeanne: Ask them a few plan the place they’ve a simple time getting it permitted for any individual together with your situation the place it all the time goes by.
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 following step. As a result of you possibly can’t plan every little thing. Typically you get sick, with one thing new. No planning for that.
And typically, your insurance coverage is unquestionably not gonna say sure straight away to the drug your doc thinks you want. And your doc thinks you want this explicit 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 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 lots of wins.
Dan: We reached John in his main workplace — also referred to as his automotive.
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 suggestions.
And one, I like only for the perspective. Right here’s John studying from the e-mail he despatched us:
John: Step therapies. Uh, denials and worth at pharmacy must be considered as strategies.
Dan: Options. Excellent. The opposite is rather more particular. As a salesman, an enormous a part of John’s job is prepping medical doctors for the fights they’re gonna have with insurance coverage corporations, to get approvals for medication. 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 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: when you’re combating 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 depart some at entrance for you.
Dan: Really, your supplier could 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 handle one thing massive: Like John joked about as we launched him, pharma gross sales reps are NOT usually appeared upon as mannequin residents.
The rap is: A few of them use less-than-scrupulous techniques to encourage medical doctors to prescribe costly medication… even to sufferers who won’t get additional profit from a selected drug. Or, within the case of opioids — which bought pushed actually laborious — may 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 techniques don’t permit any of their employees to fulfill with them.
However you don’t should approve of how pharmaceutical corporations do their enterprise to benefit from 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 medical doctors 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 will probably be limits.
John: Some producers don’t even do samples. So it actually varies so much. Dan: However lots of these samples do exist —
And the thought of utilizing them as a stopgap when you battle 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 suggestions.
And also you additionally despatched us this: Might an area clinic provide the meds you want for a worth 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 protecting well being points in America. Their journalists do superb work. We’re honored to be their colleagues.
OK, a complete new sort of skilled right here. Like Jeanne, who we heard from earlier. Cristy Gupton additionally lives in North Carolina. She works as an unbiased 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 instructor 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 true gear-head within the room .
Cristy Gupton: By the point I put the engine again collectively, it really works twice nearly 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 corporations — for customized options. It’s a WHOLE THING, and super-interesting, and price going into.
For now, she’s bought one massive tip that *some* of us might use to get entry to meds at super-low costs. Mainly it’s this: Search for a group well being heart that provides a sliding scale. They’ll get medication at extraordinarily low costs, by a federal program known as 340B.
How low?
Cristy Gupton: The drug Humira is among the most pharmaceuticals in America. And the record worth 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 record worth 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 every kind 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 specialists, right here’s what we predict you could 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 people 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: group well being facilities DO must make medication 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 so much.
But it surely’s lots of people: Greater than 28 % 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 bought a hyperlink wherever you’re listening to this. Discover a clinic in your space, name them, and see what the deal is.
One last item to know: You’ve gotta truly be a affected person on the clinic with the intention 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 need to have interaction too deeply with the clinic– don’t need to change over all of your care to a brand new crew — Cristy says, in her expertise, you could 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 bought a hyperlink to the search instrument for locating a well being heart close to you. Which after all…close to you… not all people is gonna have. Your mileage could range, actually. However is it value checking? Yeah, I believe so.
OK we’ve thrown a LOT at you. I do know, I do know. And we do have yet another set of skilled suggestions. From somebody we’re actually glad to have met. So right here’s Erika — and her experience is a part of a lifelong mission.
Erika: You realize, as a toddler with Kind one diabetes, I had a really dysfunctional family and I needed to maintain myself from a really younger age. I’ve realized that the talents that I developed as a toddler with a continual 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 somewhat.
Emily: I reside 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: Many of the sufferers Erika does work with are managing continual 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 instructed on discharge to maintain it elevated and hold it clear. Nicely in the event that they’re residing 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, probably the most frequent 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 determine which medication their insurance coverage covers, at what worth 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 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 approach that insurance coverage will make the appropriate medication inexpensive for her sufferers– together with people 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” based mostly on earnings. Some are from producers, others come from non-public foundations.
Erika: It’s such a matter of any individual realizing who to ask and the place to get the stuff.
Dan: And there are web sites to seek out this type of factor — we’ve bought hyperlinks and guides for you — and she or he says the functions aren’t sophisticated.
However the folks she works with, they want additional assist.
Erika: Lots of my sufferers don’t even know how you can use a pc or to get onto the web, or they don’t have sensible telephones, they simply have cell telephones. So lots of them, I meet with them. I take my laptop computer, and we do an internet software. 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 all people will get assist.
Erika: It’s a irritating battle. I really feel unhealthy that individuals should wage this, , 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 hold themselves alive. It’s, it’s like asking for oxygen. Like what if you happen to had been instructed you you couldn’t afford oxygen? That’s the way in which folks really feel typically.
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, critically, I don’t count on them to get tattoos. However as a affected person who manages a continual 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 many times 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 somewhat bit too. Like, okay, let’s cease and do some respiration 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 respect that about your self. Okay? you’ve been on the telephone together with your insurance coverage firm for half-hour.
You’re making an attempt to get this carried out. You really want to understand that you simply’re doing that to your well being. On your well being. Be ok with that, no less than.
Dan: You take time to take heed 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 carried out our greatest to write down them down for you, and manage them in order that they’re helpful, in our First Assist Package publication. 4 installments.
Yow will discover these newsletters — and these episodes — at Arm and a Leg present, dot com, slash, medication.
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 medication. There’ll be a hyperlink wherever you’re listening to this.
And also you’ll discover yet another 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 tune. Nicely, with the assistance of an AI. Keep tuned after the credit for somewhat style of that.
We’ll be again with a brand new episode in a number of weeks.
Until subsequent time, maintain 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 unbiased 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’ll be able to study extra about INN at INN.org.
Lastly, thanks to all people who helps this present financially. You’ll be able to take part any time at Arm and a Leg present, dot com, slash: assist.
And NOW….somewhat deal with.
So: At one level, we had 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 truly writing one, with AI supplying the melody and the band — it simply kinda confirmed us how infinite and ridiculous the record truly is.
And we discovered that simply cute. Right here’s the way it begins…
AI Music: I’m a prescription – remedy. And as you may know, I’m Costly on this nation. Getting me may be complicated. And sometimes fairly scary. Since relating to meds. The costs can range. Fortunately, there’s some tips you possibly can strive. Once you’re on this state of affairs and the worth is excessive…
Dan: Alright, I believe you get the thought — and if you need extra, it’s all at Arm and a Leg present dot com, slash, medication. Together with these podcast episodes and First Assist Package publication installments, and every little thing we hope you’ll truly 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 crew at “An Arm and a Leg,” subscribe to its weekly publication, First Assist Package. You may also comply with the present on Fb and the social platform X. And if you happen to’ve bought tales to inform in regards to the well being care system, the producers would like to hear from you.
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KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF—an unbiased supply of well being coverage analysis, polling, and journalism. Be taught extra about KFF.
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