Many people find that the arthritis drugs they have been prescribed are not accessible to them. The inaccessibility can be due to lack of insurance coverage, low income, or denials from insurance companies. Soaring prescription prices also compound the problem of inaccessibility. Butwhen access to prescription drugs seems like a dead-end, there may still be other avenues to try. In the May-June 2000 issue of Arthritis Today, the official publication of the Arthritis Foundation, some sound advice is offered which can help bring necessary medications within reach. There are particular do's and don'ts which can improve your chances to obtain what you need.
Be A Savvy Consumer
If you are a health insurance subscriber, learn exactly what your plan covers. Familiarize yourself with the schedule of benefits and know its limits. Determine what medications are on the list of approved drugs, called the formulary.If you have a choice of plans, compare benefits and formularies. Remember also that formularies can change, so be sure you are updated.
Be Careful If You Shop Internationally
Many drugs can be obtained at significantly lower prices outside the United States, in Canada and Mexico. When considering the potential savings, remember that U.S. law prohibits purchasing drugs which are not approved by the FDA (Food and Drug Administration). Foreign copies of approved American drugs are also prohibited. There is no assurance that you will receive genuine prescription drugs in foreign countries.
Ask Your Doctor For Help
Seek the help of your doctor by asking him/her to write a letter. Initial refusal by an insurance company to pay for a prescription may possibly be reversed if your doctor explains in a letter the absolute necessity of the drug in your particular case.
Talk To Your Benefits Director
If you have healthcare coverage through your employer, view the benefits director as a supporter and someone who can help you. The benefits director is often in a position to influence the insurance company. Explain your problem to the benefits director and enlist their help. The benefits director may be your link to a positive outcome.
Look Into Assistance Programs
Pharmaceutical assistance programs are offered by many drug companies for people in medical and financial need. The requirements for qualification can vary among the different drug companies but all of them call for:
- an application
- a prescription
- a doctor's signature
People considered for assistance programs are typically uninsured with low income but some people qualify with higher income.
Check the Drug Hotline list:
Arava (leflunomide)
800-552-3656
assistance program applications
Arthrotec
800-542-2526
assistance program-dr.must call
Celebrex (celecoxib)
800-542-2526
assistance program-dr.must call
Enbrel (etanercept)
800-282-7704
waiting list for assistance program
Injectable methotrexate
800-321-4669
assistance program
Methotrexate tablets
800-568-9938
assistance program-dr.must call
Naprosyn (naproxen)
800-526-6367
assistance program
Plaquenil (hydroxychloroquine)
800-446-6267
assistance program
Prosorba
800-255-7277
info about insurance & Prosorba
Remicade (infliximab)
800-964-8345
assistance program
If the drug you need is on the list:
- Call the drug manufacturer (in some cases your doctor must make the call)
- Inquire about their pharmaceutical assistance program
- Request an application
- Once the application is received, fill it out and have your doctor sign it
- Your doctor must furnish a valid prescription
- If your application is approved the drug is mailed to your doctor's office
For a small to modest fee, there are organizations which can help with the paperwork. The Medicine Program charges a $5 fee for each drug and refunds the fee if the application is rejected. Indigent Patient Services, Inc. charges a one-time $25 set-up fee plus $20 per medication.
