Free Programs That Help Pay for Prescription Drugs

By Barby Ingle, Columnist

I decided to write about the high cost of prescription drugs because I am personally experiencing it and also hearing from other patients who cannot afford their medications. I found a program that can help and wanted to make sure that this information gets out to others who need proper, cost-contained, and timely access to care.

Last year I had my first experience with abandoning a prescription at the pharmacy. I developed asthma symptoms and was given a first-time script for a bronchodilator inhaler medication. My primary care provider gave me 2 free samples in his office and warned me that getting the inhaler could be expensive.

When I went to pick it up the first time, I learned that my insurance co-pay was more than $100. I am doubly insured through a group health plan/PPO through my husband’s insurance, as well as having Medicare as my secondary. If I am having trouble financially with my co-pays, then I know others must be as well.

I just couldn’t afford the inhaler and told them to put it back on the shelf. That was when my Walgreens pharmacist suggested that I Google a free savings program like WellRx and see if they had any discounts for the medication I needed.

I did find a discount card online at WellRx.com that helped save on the inhaler and I was able to fill the script after all. I would have never thought of doing something like this without the suggestion of my amazing pharmacist. The WellRx savings program works well for insured people with high out-of-pocket costs like me.

I have faced this situation two more times, one with a medication I was taking daily for years. The co-pay went up so high that without a savings card, I would not be able to pay for it.

The other medication I had to abandon because I couldn’t afford it, even though the savings program provided 50% off what my insurance was going to cover. Nevertheless, it was worth the look to see if I could find a discount. My provider had to substitute the medication for a different one that I could afford, although I am not sure if it worked as well as the one he originally prescribed.

I know how awful and embarrassing it feels to have to abandon a medication at the pharmacy, while you work to come up with a way to pay for it and know that you may never be able to pick it up. Now, I have my pharmacist price the medication through insurance and the WellRx program to see which is less expensive.

Recently a study was published in the Annals of Internal Medicine that showed a direct correlation between the amount of a patient’s out-of-pocket cost and the likelihood of a prescription being abandoned. They concluded that when patients have a co-pay of over $50 they are four times more likely to abandon their prescription than patients who only owe $10.

Leaving a prescription at the pharmacy and failing to follow a doctor’s instructions can lead to major health challenges, such as a condition worsening, increased side effects and symptoms, therapeutic failure, increased medical costs, and in some cases even death. A 2008 Harvard prescription study suggested that opiates, anti-platelets and statins were the least likely to be abandoned, while insulin and proton pump inhibitors were more likely to be left behind.

This is not a new issue for pharmacies, but it has become more common over the past few years. Besides cost, some other reasons for abandoning medications at the pharmacy include e-prescriptions, drug strength, taking the medication for the first time, and not understanding why the medication was prescribed.

But for me and many others, it all comes down to cost. Studies show that the higher the patient’s responsibility financially, the greater the risk of prescription abandonment. The second highest reason for abandonment is younger customers who are wary about the trying a new medication.

The take away for me is that prescription discount cards and pharmaceutical coupons can increase medication compliance, improve patient health, and lower the cost of medical care. I know that by getting the cost down for my medications, I will be more likely to comply with my doctors’ instructions.

The WellRx program I used was free. I wasn’t sure how it was going to work the first time, but the pharmacist just said print the savings card and bring it back. He did the rest for me. He knew exactly how to ring it into their register and didn’t seem to bat an eye or look down at me for using a savings card. They also have an app for Apple and Android phones for those who prefer everything digital.

WellRx also allows you to compare what the price will be at different pharmacies in your area and to search for the best discounts. It is quick and easy, and their program is accepted at more than 60,000 pharmacies across the country. They offer an average savings of 45% off the prescription cost and some of their medications are eligible for savings of up to 80 percent.

Another free program that can help is the Partnership for Prescription Assistance, which helps uninsured and underinsured patients connect with hundreds of public and private assistance programs that provide free or low-cost prescription drugs.

I love being able to pass financial savings tips on to others. Prescription savings programs are a great tool not only for the chronically ill, but also for healthy people who have an unexpected medical problem and need help paying for their prescriptions.

Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain FoundationShe is also a motivational speaker and best-selling author on pain topics.

More information about Barby can be found at her website. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

The High Cost of Anxiety Drugs Gives Me Anxiety

By Crystal Lindell, Columnist

I recently got a new prescription for a drug that’s supposed to help with my anxiety — which is a debilitating mix caused by opioid withdrawal and what I would call a base level of anxiety that runs through my bones.

The ironic thing about what happened is that when I went to pick up the anxiety medication, the cost of the prescription nearly gave me an anxiety attack — right there at the pharmacy.

The co-pay was $65.

It gets worse. My doctor wanted to gradually move me up on the dose, so he had ordered some 10 mg pills and some 20 mg pills. The insurance company wanted me to pay $65 for EACH dose! That’s $130. 

We need to talk about co-pays. There’s this misconception in America that if you have health insurance, then you don’t have to really worry about medical bills.

But that’s so incredibly not true. 

Listen, I wish a $65 co-pay for medication was no big deal for me. I wish I could just whip out some hundos every time I stopped in the pharmacy and throw them around like confetti, but alas, I am not a rapper or a Kardashian. 

So when my insurance company tells me that the medication I am taking is “not preferred” and thus comes with a $65 co-pay, I cry a little inside. Especially since it’s a monthly prescription.

Add in a couple other meds ($25/month) and I’m looking at $90 a month for prescriptions. That’s literally an electric bill, or four tanks of gas, or about 10 percent of my rent. 

I asked the insurance company if I could appeal the fact that it’s not their preferred medication, seeing as how I had what I thought were very valid reasons. 

1)  I had a horrific reaction to the one that is preferred, and ended up in the ER.

2)  As a response to the horrific reaction to the other drug, my doctor ran genetic testing to see which meds would work best for me, and after a lot of consideration we decided on this one.

3)  This is the medication my doctor chose.

But the insurance company was basically like, “Umm, yeah, no you can’t appeal.” Something about how they do technically cover it, so there’s nothing to appeal.

They literally tried to tell me that my doctor should just prescribe one of the preferred meds, completely ignoring the fact that my psychiatrist had literally spent hours with me talking about all the pros and cons before he decided on this one.

And then they had the audacity to act like it was no big deal. But if it’s no big deal, why don’t they pay the $65 then?

My $65 co-pay is just one small example of all the ways people with insurance can still find themselves with mountains of medical bills. There’s also the $30 co-pay for every single doctor’s appointment, and the $2,500 deductibles you run into every time you’re in the ER.

I live paycheck to paycheck, and all the medicals bills can make it hard to breathe. In fact, it’s enough to give a girl an anxiety attack.

Crystal Lindell is a journalist who lives in Illinois. She loves Taco Bell, watching "Burn Notice" episodes on Netflix and Snicker's Bites. She has had intercostal neuralgia since February 2013.

Crystal writes about it on her blog, “The Only Certainty is Bad Grammar.”

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Significant Decline in U.S. Opioid Prescribing

By Pat Anson, Editor

Nearly 17 million fewer prescriptions were filled for opioid pain medications in the U.S. in 2015, driven largely by a significant decline in prescriptions for hydrocodone, according to a new report by IMS Health.

The report adds further evidence that the so-called “epidemic” of opioid abuse and addiction is increasingly being fueled by illegal opioids such as heroin and illicit fentanyl, not by prescription pain medication intended for patients.

Hydrocodone was reclassified by the Drug Enforcement Administration as a Schedule II controlled substance in October, 2014 – making 2015 the first full year that more restrictive prescribing rules for the pain medication were in effect. But hydrocodone prescriptions were falling even before the rescheduling. They peaked in 2011 at 137 million and fell to 97 million in 2015, a 30% decline.

Hydrocodone is typically combined with acetaminophen to make Vicodin, Lortab, Lorcet, Norco, and other brand name hydrocodone products. The rescheduling of hydrocodone limits pain patients to an initial 90-day supply and then requires them to see a doctor for a new 30-day prescription each time they need a refill.

“It is not surprising that we have seen a dramatic drop in hydrocodone prescribing,” said Lynn Webster, MD, past president of the American Academy of Pain Medicine and vice president of scientific affairs at PRA Health Sciences.Patients are being told they are not going to be prescribed opioids in general by many physicians. Since hydrocodone has been the most prescribed, it is the most affected. Schedule II opioids are more of a hassle so prescribers shun away from them.

“What is most striking is that the number of unintentional overdoses are still climbing despite fewer pills being prescribed.  Obviously this is a reflection that the goal to reduce harm from reduced prescribing is not working.  We have to wait to see if that trend continues.”

The Centers for Disease Control and Prevention recently adopted new guidelines that discourage primary care physicians from prescribing opioids for chronic pain. The agency also reported that 28,647 Americans died from opioid overdoses in 2014 and attributed about 19,000 of those deaths to prescription opioids. However, the CDC admits the data is flawed. Some overdoses may have been counted twice and some deaths blamed on prescription medications may have been caused by illegal opioids.

Hydrocodone Falls to #3

For several years hydrocodone was the #1 most widely filled prescription in the U.S. It now ranks third behind levothyroxine (Synthroid), which is used to treat thyroid deficiency, and lisinopril (Zestril), which is used to treat high blood pressure.

“Over 16.6 million fewer prescriptions were filled for narcotic analgesics, driven mainly by a sharp decrease in prescriptions for acetaminophen-hydrocodone, whereas prescriptions for oxymorphone, another controlled substance, increased 5.3%,” the IMS report said.

Oxymorphone is the generic name for Opana, a semisynthetic opioid that is also abused by drug addicts.  

The IMS report also found an increasing number of prescriptions being written for gabapentin (Neurontin), a medication originally developed to treat seizures that is now widely prescribed for neuropathy and other chronic pain conditions.  About 57 million prescriptions were written for gabapentin in 2015, a 42% increase since 2011.

After steadily increasing for several years, the number of prescriptions for tramadol appears to have leveled off, according to IMS. Last year about 43 million prescriptions were written for tramadol, a weaker acting opioid also used to treat chronic pain.

Overall spending in prescription drugs reached $310 billion in 2015, according to IMS, a 8.5% increase largely fueled by expensive new brand name and specialty drugs.

12 Tips to Ensure Access to Healthcare This Winter

By Celeste Cooper, Guest Columnist

When we think of winter, we think of chilly days, getting cozy under a soft fluffy blanket, or curling up with a warm drink and a good book. We think of holiday festivities, and time with family and friends.

And as we prepare for winter, maybe we should also consider a safety plan that will assure access to the healthcare we need.

Those of us who live with chronic pain or illness have learned to expect the unexpected. We know that our symptoms can escalate without warning. Some of us experience a worsening of symptoms during the cold and dry winter months.  We may need additional medications to manage our symptoms or make more frequent visits to the doctor than usual. We need to do something to make sure our needs are met.

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The following are some suggestions to make the winter months less intimidating:

1. Know what’s in your medicine cabinet. Take an inventory of medications, including prescriptions and over-the-counter drugs.

2. Dispose of outdated prescriptions, vitamins or supplements by following the Food and Drug Administration's guide on “How to Dispose of Unused Medicines."

3. If a replacement prescription is needed, ask your doctor or pharmacy for a refill now.

4. Know your insurance company’s policies on early refills before a winter storm hits.

5. If transportation or road conditions interfere with your ability to obtain a prescription, a substitute medication may be needed. Be sure to clarify with your pharmacist any differences in the medications or things to watch for.  

6. Most medical practices have a cancellation policy, sometimes imposing a fee if you don’t give 24-hour notice. Ask your doctor’s staff about their policy when a winter storm prevents you from keeping an appointment.

7. Identify your support network in case someone needs to pick up a prescription for you or provide transportation to the doctor.

8. Get to know your pharmacist so they can help you anticipate your needs. Ask for their business card and keep it where it is readily available, especially if you are not the one picking up your prescription.

9. Check to see if a pharmacy in your area delivers. If it’s not in your insurance network, check to see if your insurance carrier will make an exception under special circumstances.

10. Have information on an alternate pharmacy handy in case yours does not have the medication you need. Pharmacy inventories can also be affected by winter weather.

11. Consider using a mail order prescription plan. Paperwork from your physician may be required.

12. If you already use mail delivery for your medications, contact the supplier. Ask them how they protect your medications from extreme temperatures during shipment. Frigid temperatures can alter the potency and stability of certain medications. Even if you live in a temperate area, your medications may travel through areas that are not.

Let your doctor and pharmacist know you have an action plan and ask them for any suggestions that will assure your access to medication this winter.

As you get ready for winter and make plans for the holidays, also consider how you will manage your healthcare needs. If you are prepared, you can enjoy a healthier and safer winter.

Celeste Cooper, RN, is an advocate, freelance writer and author. She is also a person living with chronic pain. Celeste is lead author of Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain, and the Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain book series.

Celeste enjoys spending time with her family and the rewards she receives from interacting with nature through her writing and photography. You can learn more about Celeste’s writing, advocacy work, helpful tips, and social network connections at her website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Florida’s ‘Modest’ Reduction in Opioid Prescribing

By Pat Anson, Editor

Florida was one the first states in the country to get serious about fighting the “epidemic” of prescription drug abuse.

In 2010, a year when eight Floridians were dying every day from drug overdoses, the state started cracking down on rogue pain clinics – “pill mills” -- and began to closely monitor the number of opioid prescriptions written and filled by physicians and pharmacies.

By most accounts, the crackdown has been a success – overdose deaths dropped and over 250 pain clinics were closed. But legitimate pain patients also began to complain that they couldn’t get their prescriptions filled. Their search for a pharmacy willing to dispense opioids – a search that could take hours or days – even got a name: Florida’s “Pharmacy Crawl.”

Which makes a new study in JAMA Internal Medicine all the more surprising.

Researchers analyzed an extensive database of prescription claims and found that there was only a “modest” decline of 1.4 percent in the number of opioid prescriptions in Florida from 2010 to 2012.

The reductions were generally limited to prescribers and patients with the highest rates of opioid prescribing and use – meaning the average pain patient shouldn’t have been affected at all.

That 1.4% reduction, researchers say, was a “statistically significant” decline by some measures. But they also acknowledge that Florida’s crackdown on opioids “had no apparent effect on days’ supply per transaction or on total number of opioid prescriptions dispensed.”

That less than overwhelming finding raises questions about the effectiveness of the crackdown and, in particular, prescription drug monitoring programs (PDMPs). Almost every state has implemented a PDMP in the last few years, spending millions of dollars to track patients with electronic databases that have yet to be proven effective. 

“Our findings highlight the need for more evidence demonstrating the effect of PDMP and pill mill laws,” wrote lead author Caleb Alexander, MD, of the Johns Hopkins Bloomberg School of Public Health.

Effect on Pain Patients

So if the number of opioid prescriptions in Florida barely budged, what about all those pain patients who claim they couldn’t get a prescription filled?

"The opioid lobby and media they've influenced portray Florida's efforts as draconian. We keep hearing that pain patients in Florida have lost access to opioids.  The study's findings refute these claims," said Andrew Kolodny, MD, a prominent critic of opioid prescribing practices who is President of Physicians for Responsible Opioid Prescribing.

“Dr. Kolodny can't see the whole picture just by looking at this short term study,” says Donna Ratliff, a chronic pain patient who founded the Fight for Pain Care Action Network, a non-profit group lobbying for adequate pain care in Florida.

“Things did get draconian after the DEA fined the distributors and chain pharmacies. The media headlines stigmatized the pharmacies and doctors early on into not treating legitimate pain patients out of fear.” 

It was in 2012 that Cardinal Health, one of the nation’s largest drug wholesalers, was fined $34 million by the DEA after it failed to report suspicious orders for hydrocodone at a distribution facility in Lakeland, Florida. Shipments of controlled substances from that facility were suspended for two years.

Walgreens and CVS Pharmacy were also fined tens of millions of dollars for violating rules and regulations for dispensing controlled substances. Afterwards, both pharmacy chains began to screen patients with opioid prescriptions more carefully, and told their pharmacists not to fill them if anything appeared suspicious.

Those developments, according to Ratliff, were not fully covered during the opioid prescription study, which ended in September 2012.

“This induced the pharmacy crawl, that got worse as time went by,” she told Pain News Network.

In a recent survey of hundreds of pharmacies, drug wholesalers and physicians by the General Accounting Office (GAO), over half said DEA enforcement actions had limited their ability to supply drugs to patients. Many said they were fearful of being fined or having their licenses revoked by the DEA.

“Some pharmacies may be inappropriately delaying or denying filling prescriptions for patients with legitimate medical needs,” the GAO report states.