In response to the excessive worth of pharmaceuticals, “An Arm and a Leg” requested listeners to share their methods for getting the drugs 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 best Medicare plans, a pharmaceutical gross sales rep, an worker advantages adviser, and a battle-worn hospital caseworker. Every brings stunning, possibly even lifesaving, info to the desk.
Discover the complete crowdsourced collection, together with 5 installments of the “First Help Equipment” publication: 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.
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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 comprise 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 usually talks with people who take like 15 totally different meds day-after-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 work out methods 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 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 individuals can decide new insurance coverage for the approaching 12 months– Jeanne says she and her staff communicate to greater than 100 individuals every week.
And one factor that comes up in mainly ALL of these conversations: Can I modify 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 individuals 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 fully on the price of their medication.
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 tips for coping with the excessive value of pharmaceuticals.
The end result: two podcast episodes– that is quantity two — and 4 installments of our First Help Equipment publication.
On this episode, we’re gonna hear from Jeanne and three different *unimaginable* sources who got here to us with essential insider data. Data 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 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 particular tip she wrote in with, her work – and life story – are gonna carry us some deeper perspective.
These individuals kick ass.
And for all their recommendation, there’s, in fact, a BIG caveat:
like we stated final episode — your mileage will fluctuate. There is no such thing as a one answer 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 a giant purpose they’re so patchy and unreliable.
We deserve SO significantly better. However within the meantime, we may also help one another. That’s what this undertaking 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 just stroll away from all of this armed with a *little* extra data that might enable you 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 possibly 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 must scramble generally.
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 supplies an ideal template for any of us.
The first step: Google for reductions. Simply taking a fast first move on the sort 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 stated, is there one thing else that you are able to do?
Dan: Jeanne was considering: Perhaps the doc may suggest one other antibiotic — one which insurance coverage would cowl. Or assist them battle her husband’s insurance coverage to get this drug lined.
However truly, the doc’s proposal was a lot easier.
Jeanne: She stated 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 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 great guess for you. If not… effectively… 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 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 take a look at the listing 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 may 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 drugs. And final 12 months, or final month in December, it was $30.
Dan: These people didn’t plan to alter something about their insurance coverage — however their insurance coverage plan modified on them– and stopped overlaying 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 in all probability discovered a plan that lined that drug nonetheless..
Dan: Now, it’s true that people on Medicare are inclined 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 select from.
In case you get insurance coverage from work — and possibly there’s only one plan — this factor of wanting forward is possibly much more essential.
In some unspecified time in the future, possibly 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 may say, “Hey, your drug is gonna be dearer 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: Test: Can you discover reductions on-line that make this drug inexpensive? 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 doubtless prescribes this treatment quite a bit.
Dan: And so, in case your insurance coverage firm says they’ve bought another drug you could possibly take, one they’ll pay for– your supplier will know: may 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 in every of them extra more likely to truly subject that approval?
Jeanne: Ask them a few plan the place they’ve a straightforward time getting it permitted for any individual along with your situation the place it all the time goes via.
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 following step. As a result of you’ll be able to’t plan every little thing. Generally you get sick, with one thing new. No planning for that.
And generally, 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 beneath 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 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 main workplace — also called his automobile.
Once 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 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 options.
Dan: Solutions. Good. The opposite is rather 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 firms, 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 finished.
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 just strive 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 go away some at entrance for you.
Dan: Really, your supplier might have already got some 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 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 medication… even to sufferers who may not get further profit from a particular drug. Or, within the case of opioids — which bought pushed actually arduous — may trigger hurt. And free samples are a part of that course of.
So, some suppliers received’t meet with gross sales reps in any respect. Some well being techniques don’t permit any of their workers to satisfy with them.
However you don’t must approve of how pharmaceutical firms 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 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 quite a bit. Dan: However a whole lot of these samples do exist —
And the concept of utilizing them as a stopgap whilst 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’ll be able to 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 overlaying 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 impartial worker advantages designer. You’re in all probability 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 previous 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 employees. 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 nearly as good, however at half the fee.
Dan: Cristy says she does it by ditching costly, off-the-shelf elements — normal insurance coverage insurance policies from huge firms — for customized options. It’s a WHOLE THING, and super-interesting, and price going into.
For now, she’s bought one huge tip that *some* of us may use to get entry to meds at super-low costs. Mainly it’s this: Search for a group well being middle that provides a sliding scale. They’ll get medication at extraordinarily low costs, via a federal program known as 340B.
How low?
Cristy Gupton: The drug Humira is among the most pharmaceuticals in America. And the listing worth might be someplace within the neighborhood of 5,000 a month. However a 340B lined entity may buy it for a penny.
Dan: So we checked, and truly: Humira’s listing 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 figuring out about, it’s not assured to be just right for you.
340B is difficult in all types 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 expect it is advisable know:
A federal regulation from the Nineties — part 340B of that regulation — mainly requires drug-makers to present 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 have to make medication inexpensive to individuals with decrease incomes. Particularly, to individuals who make lower than two instances the federal poverty degree.
For 2025, that’s simply over 64 thousand {dollars} for a household of 4. Not quite a bit.
However it’s lots of people: Greater than 28 p.c of People qualify. And a few clinics might have sliding scales for individuals with increased 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 a view to use this program. And really, if you happen to meet the revenue 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 swap over all of your care to a brand new staff — Cristy says, in her expertise, it’s possible you’ll not must.
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 bought a hyperlink to the search instrument for locating a well being middle close to you. Which in fact…close to you… not all people is gonna have. Your mileage might fluctuate, 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 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 undertaking.
Erika: , as a toddler with Sort one diabetes, I had a really dysfunctional family and I needed to handle myself from a really younger age. I’ve discovered that the abilities that I developed as a toddler with a continual 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 sort of case employee, at a hospital in rural Oregon.
When my colleague Emily talked with Erika, they bonded a bit.
Emily: I dwell with Sort One Diabetes and I actually want that I had had a affected person navigator, um, once I was recognized.
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 robust circumstances.
Erika: For instance, let’s say a affected person has an amputation and so they’re advised on discharge to maintain it elevated and preserve it clear. Effectively 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 resort for a pair weeks.
Dan: And naturally, some of the frequent 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 work out 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 means that insurance coverage will make the best 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” primarily based on revenue. Some are from producers, others come from personal foundations.
Erika: It’s such a matter of any individual figuring out who to ask and the place to get the stuff.
Dan: And there are web sites to seek out this sort of factor — we’ve bought hyperlinks and guides for you — and he or she says the functions aren’t difficult.
However the individuals she works with, they want further assist.
Erika: A whole lot of my sufferers don’t even know methods to use a pc or to get onto the web, or they don’t have sensible telephones, they only have cell telephones. So a whole lot of them, I meet with them. I take my laptop computer, and we do a web based 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 all people will get assist.
Erika: It’s a irritating battle. I really feel unhealthy that individuals must wage this, , to get what they should be wholesome. It’s, it’s not like individuals are asking for BMW or new clothes. Persons are asking for, oftentimes drugs they should preserve themselves alive. It’s, it’s like asking for oxygen. Like what if you happen to had been advised you you couldn’t afford oxygen? That’s the best way individuals really feel generally.
Dan: And that’s why, although Erika wrote to us about sensible specifics, it’s her strategy, 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 must be.
Dan: Oh yeah. The continued burden of coping with all this, it’s a bear. And it got here up many times while 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 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 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 cellphone along with your insurance coverage firm for half-hour.
You’re attempting to get this carried out. You actually need to understand that you just’re doing that to your well being. To your well being. Be ok with that, at the very least.
Dan: You take 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, that will or might not work — we’ve carried out our greatest to jot down them down for you, and arrange them so that they’re helpful, in our First Help Equipment publication. 4 installments.
You’ll find 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 discovered by strolling via 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 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 countless and ridiculous course of that we generally must undergo to get our medicines… my colleague Claire Davenport, who has led the reporting for a lot of this collection, made an countless and ridiculous music. Effectively, with the assistance of an AI. Keep tuned after the credit for a bit style of that.
We’ll be again with a brand new episode in a number of weeks.
Until subsequent time, handle 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 because of 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 be taught 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: help.
And NOW….a bit deal with.
So: At one level, we had been like, “What if we may make like a jingle to assist individuals bear 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 countless and ridiculous the listing truly is.
And we discovered that simply cute. Right here’s the way it begins…
AI Track: I’m a prescription – treatment. And as you may know, I’m Costly on this nation. Getting me will be complicated. And infrequently fairly scary. Since in terms of meds. The costs can fluctuate. Fortunately, there’s some tips you’ll be able to strive. Once 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, medication. Together with these podcast episodes and First Help Equipment 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 Street Productions.
For extra from the staff at “An Arm and a Leg,” subscribe to its weekly publication, First Help Equipment. It’s also possible to observe the present on Fb and the social platform X. And if you happen to’ve bought tales to inform concerning 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 impartial supply of well being coverage analysis, polling, and journalism. Study extra about KFF.
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