Falling into the Health Insurance Chasm With Asthma


Editor's Note: This article was originally written by patient expert Nancy Sanker.

So what happens when your 28-year-old son has an unexpected health insurance gap and is sick? You get a blazing-fast education in how to find a health care professional who will even see you without that magic card and then you try to figure out how to finance the required tests and then, the toughest part, you try to find asthma medications that are not laughably unaffordable.

My mom used to say that you cannot understand another person's challenges until you "walk a mile in his moccasins." Ok then - I now have enough compassion for three people. But compassion can only go so far when your son has joined the new club of the uninsured - one that is made up of 27% of adults between the ages of 25 and 34 U.S., according to a Kaiser Family Foundation analysis of Census Bureau data.

And his story is becoming more common each day, helping to catapult health care for the uninsured toward the top of Washington issues for the first time in more than a decade. Sheer mass dictates this shift of priorities as nearly 16% of Americans, more than 46 million, lack health insurance. It's hard to refrain from filling this blog with additional startling statistics, but my mantra has always been to share what I've learned so here are some important tips.

Some communities are lucky to be able to offer medical care to the uninsured or underinsured. After several calls, it was clear that ours was not one of them and we were directed to an Urgent Care Clinic where, for a whooping $150 my son was diagnosed and prescribed medications.

This brought us to the beginning of our learning curve; we caught on that we needed to clearly communicate his lack of insurance to the health care professional. If you're lucky, there may be samples available or at the very least, you might be as fortunate as we were to receive directions to the least expensive pharmacy. We were victorious (well, partially victorious) - one of the medications was on the $4 list at the mega-store, but the others cost the equivalent of  two weeks of groceries After a quick price check at other local pharmacies, we began to learn about Patient Assistance Programs (PAPs).

Getting Your Asthma Medication

Most pharmaceuticals have set up PAPs for their products so you can start by searching for your specific medication. Follow the easy steps on any site to see if you qualify. PAPs will have different eligibility criteria based on a specific income per individual or on a percentage (usually 200%, 250% or 300%) of the federal poverty level for families (FPL). For example, 200% of the 2008 FPL income for a family of four is $42,400 a year.

Sometimes an advocate, such as a health care professional at the physician's office or a caseworker, must complete an enrollment form. After completion, you should check the paperwork! If part of it is unreadable or if there is a blank, your application may be denied. Put N/A (not applicable) in any blank space if the item does not apply to you. Make copies of everything you submit. Providing the doctor's office with a pre-addressed stamped envelope to use to send in the application or highlighting the fax number will help facilitate the process.

Another approach is to visit the Partnership for Prescription Assistance at www.pparx.org (or call toll-free at 1-888-4PPA-NOW) to access more than 475 public and private assistance programs, including 180 programs offered by pharmaceutical companies.

There's more help at www.NeedyMeds.com, a 10-year old non-profit. This valuable site links you to multiple medications (including generics) and their corresponding PAPs, which frequently change as medications are added/dropped, dosages may change and new programs sometimes appear.

NeedyMeds also offers help with paperwork, access to disease-based programs, details regarding state programs, discount drug cards and even tax return request forms. A Patient Advocate Newsletter, NeedyMeds Brochure and other resources, including a tracking program for offices, are available specifically for advocates at this site.

The bottom line is that resources exist for individuals who have on-going problems and the compassionate people who endeavor to help them...er... us. It's all there for those of us who have the time, expertise and computer to search for assistance. Ultimately, my son regained his health and I gained awareness with a healthy dose of empathy on the side.