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’ll handle.
Host Dan Weissmann and producers Emily Pisacreta and Claire Davenport share suggestions 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, perhaps even lifesaving, data to the desk.
Discover the total crowdsourced sequence, together with 5 installments of the “First Help 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 % 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
Word: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can comprise errors. Please use the transcript as a device however verify the corresponding audio earlier than quoting the podcast.
Dan: Hey there. Let’s meet Jeanne Chamberlin from North Carolina. She frequently talks with of us who take like 15 completely different meds every single day.
Jeanne Chamberlin: You’re 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 the way to 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 Info 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.
In the course of the busy season — that’s within the fall, when individuals can decide new insurance coverage for the approaching 12 months– Jeanne says she and her workforce communicate to greater than 100 individuals every week.
And one factor that comes up in principally ALL of these conversations: Can I modify issues to get my meds for much less subsequent 12 months?
She says one 12 months, her workforce added up the affect of these conversations. Half of the individuals modified plans, and on common, they saved 300 {dollars}. Not dangerous…
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 solely on the price of their medicine.
Dan: Jeanne’s gonna inform us how she helps individuals get these sorts of financial savings– with methods that aren’t only for individuals on Medicare.
And Jeanne is only one one who wrote to us once we requested for you, our listeners, to inform us about your techniques and methods for coping with the excessive value of prescribed drugs.
The consequence: two podcast episodes– that is quantity two — and 4 installments of our First Help 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. Information 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 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 convey us some deeper perspective.
These individuals kick ass.
And for all their recommendation, there may be, after all, a BIG caveat:
like we mentioned final episode — your mileage will range. There isn’t a one resolution for everybody. It is a set of patches, workarounds, bandaids.
To be trustworthy, a whole lot 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 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 just stroll away from all of this armed with a *little* extra information that would assist you 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 will 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 individuals 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 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 downside fixing mode. And her order of operations supplies an incredible template for any of us.
The first step: Google for reductions. Simply taking a fast first go on the type 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 may 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 considering: Perhaps the doc may 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 may get for thirty bucks. Skip the second drug.
Jeanne: So he did, and he was effective!
Dan: END OF STORY. On this case. It’s not all the time that simple. However the ethical is: ASK. In case your insurance coverage covers a special drug, your doc can inform you if it’s an excellent wager for you. If not… properly… we’ll come again to different methods your doc may assist.
However proper now let’s transfer on to the most important, most dear recommendation Jeanne provides 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 join subsequent 12 months’s insurance coverage plan: Get a have a look at the checklist of which medicine 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 when you don’t change something about your insurance coverage, your insurance coverage may 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 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 may have most likely discovered a plan that coated that drug nonetheless..
Dan: Now, it’s true that people on Medicare are inclined to have extra decisions 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 select from.
When you get insurance coverage from work — and perhaps there’s only one plan — this factor of trying forward is perhaps much more essential.
Sooner or later, perhaps a pair months earlier than the brand new 12 months, you need to get an opportunity to see that subsequent 12 months’s formulary
And it may say, “Hey, your drug is gonna be dearer for you subsequent 12 months”
That’s your cue to start out problem-solving instantly. 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 reasonably priced? 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 possibly prescribes this remedy rather a lot.
Dan: And so, in case your insurance coverage firm says they’ve acquired another drug you possibly can take, one they’ll pay for– your supplier will know: may that drug give you the results you want?
And when you’ve acquired a selection of plans — however all of them require a particular approval course of now to your drug — your supplier will know: Is considered one of them extra more likely to really situation that approval?
Jeanne: Ask them a couple of plan the place they’ve a simple time getting it accredited for any person along with your situation the place it all the time goes by.
Dan: And that’s the plan you wish to decide. 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 the whole lot. Generally you get sick, with one thing new. No planning for that.
And typically, your insurance coverage is unquestionably not gonna say sure instantly 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 trade with an approval ranking beneath Congress.
Dan: He’s a pharmaceutical gross sales rep! He requested us to maintain his full identify and employer confidential.
He’s additionally an Arm and a Leg fan.
John: I find it irresistible when, uh, I hear tales of common individuals simply sticking it to the insurance coverage firm. It’s good when the affected person wins, trigger they don’t get a whole lot of wins.
Dan: We reached John in his major workplace — also called his automotive.
Once we requested listeners a couple 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 really 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 ought to be seen as recommendations.
Dan: Strategies. 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 medicine. 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 understand doesn’t care about time is ailments.
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 preventing 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 depart some at entrance for you.
Dan: Really, your supplier could have already got some available. A research from a couple of years in the past discovered that TWO THIRDS of primary-care practices had CLOSETS of pharmaceutical samples. Which, wow.
So, let’s tackle one thing large: 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 medicine… even to sufferers who may not get additional profit from a selected drug. Or, within the case of opioids — which acquired pushed actually onerous — 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 methods don’t enable any of their workers to satisfy 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 may not 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 shall be limits.
John: Some producers don’t even do samples. So it actually varies rather a lot. Dan: However a whole lot of these samples do exist —
And the concept of utilizing them as a stopgap when 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 suggestions.
And also you additionally despatched us this: Might a neighborhood clinic provide the meds you want for a worth 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 protecting well being points in America. Their journalists do wonderful work. We’re honored to be their colleagues.
OK, an entire new type 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 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 elements — normal insurance coverage insurance policies from large corporations — for customized options. It’s a WHOLE THING, and super-interesting, and value going into.
For now, she’s acquired one large tip that *some* of us may use to get entry to meds at super-low costs. Mainly it’s this: Search for a neighborhood well being heart that provides a sliding scale. They’ll get medicine at extraordinarily low costs, by a federal program known as 340B.
How low?
Cristy Gupton: The drug Humira is likely one of the most prescription drugs in America. And the checklist worth might be someplace within the neighborhood of 5,000 a month. However a 340B coated entity may buy it for a penny.
Dan: So we checked, and truly: Humira’s checklist 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 price understanding about, it’s not assured to give you the results you want.
340B is sophisticated in every kind of how. 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 finest, um, like solely know sufficient to be harmful reply.
Dan: After checking some precise specialists, right here’s what we predict it is advisable 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 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 have to make medicine reasonably priced to individuals 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 % of People qualify. And a few clinics could have sliding scales for individuals with greater incomes than that.
So: There’s a search device. 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 to be able to use this program. And really, when you meet the earnings necessities, all of the clinic’s companies are gonna be super-subidized.
However when you don’t wish to have interaction too deeply with the clinic– don’t wish to swap over all of your care to a brand new workforce — Cristy says, in her expertise, you might not should.
Cristy Gupton: It may be as unfastened as they simply have a digital go to. I imply, that’s fairly easy.
Dan: Once more, we’ve acquired a hyperlink to the search device for locating a well being heart close to you. Which after all…close to you… not everyone is gonna have. Your mileage could range, actually. However is it price checking? Yeah, I feel 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 challenge.
Erika: You recognize, as a baby with Sort one diabetes, I had a really dysfunctional family and I needed to deal with myself from a really younger age. I’ve discovered that the talents that I developed as a baby with a persistent sickness are transferable right into a profession to assist individuals 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 dwell with Sort 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 circumstances and different severe well being issues, beneath robust 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 maintain it clear. Effectively 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, one of the widespread issues she tackles: serving to individuals 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 determine which medicine their insurance coverage covers, at what worth 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 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 approach that insurance coverage will make the suitable medicine reasonably priced 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 personal foundations.
Erika: It’s such a matter of any person understanding who to ask and the place to get the stuff.
Dan: And there are web sites to search out this sort of factor — we’ve acquired hyperlinks and guides for you — and he or she says the purposes aren’t sophisticated.
However the individuals she works with, they want additional assist.
Erika: A number of my sufferers don’t even know the way to use a pc or to get onto the web, or they don’t have sensible telephones, they simply have cell telephones. So a whole lot of them, I meet with them. I take my laptop computer, and we do a web based 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 everyone will get assist.
Erika: It’s a irritating struggle. I really feel dangerous that folks should wage this, you understand, to get what they must be wholesome. It’s, it’s not like persons are asking for BMW or new clothes. Persons are asking for, oftentimes drugs they should maintain themselves alive. It’s, it’s like asking for oxygen. Like what when you have been informed you you couldn’t afford oxygen? That’s the way in which individuals really feel typically.
Dan: And that’s why, regardless that 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, severely, I don’t count on them to get tattoos. However as a affected person who manages a persistent 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 time and again once 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 train to my sufferers a bit of 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 individuals see how a lot they’re already doing.
Erika: I encourage individuals to take a second and respect that about your self. Okay? you’ve been on the telephone along with your insurance coverage firm for half-hour.
You’re attempting to get this performed. You really want to understand that you just’re doing that to your well being. On your well being. Be ok with that, at the 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 attempt, that will or could not work — we’ve performed our greatest to jot down them down for you, and manage them so that they’re helpful, in our First Help 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 tackle the place we first requested you to share what you’d discovered by strolling by this maze. Now we’re inviting you to come back and see what we’ve discovered 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 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 sequence, made an infinite and ridiculous track. Effectively, 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 couple 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 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 because of the Institute for Nonprofit Information for serving as our fiscal sponsor.
They permit us to just accept tax-exempt donations. You may study extra about INN at INN.org.
Lastly, thanks to everyone who helps this present financially. You may 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 may make like a jingle to assist individuals 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 lovable. Right here’s the way it begins…
AI Tune: I’m a prescription – remedy. And as you may know, I’m Costly on this nation. Getting me will be complicated. And sometimes fairly scary. Since with regards to meds. The costs can range. Fortunately, there’s some methods you’ll be able to attempt. While you’re on this state of affairs and the value is excessive…
Dan: Alright, I feel you get the concept — and if you’d like extra, it’s all at Arm and a Leg present dot com, slash, medicine. Together with these podcast episodes and First Help Package e-newsletter installments, and the whole lot 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 workforce at “An Arm and a Leg,” subscribe to its weekly e-newsletter, First Help Package. You may also comply with the present on Fb and the social platform X. And when you’ve acquired tales to inform concerning the well being care system, the producers would like to hear from you.
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