The Financial Challenges of Osteoporosis Treatments
Do you have insurance; are you underinsured or do you have great employer insurance benefits? On OsteoporosisConnection.com we get questions from members who don’t have insurance are underinsured or they have a plan that doesn’t cover what their doctor prescribed. Charlotte asked: “I don’t have insurance and had the Reclast infusion from Novartis, under the patient assistance program. The cost of this infusion is very expensive even with the patient assistance plan, are there any other options? If I pay for the infusion I can’t pay rent.” Mrs. Beezer asked: “Without insurance coverage, how much does Reclast cost?” Eileen asked: “I am enrolled in Humana Gold Plan. My Doctor has arranged for me to receive an injection of Reclast. My co-payment is $232.96. I cannot afford the co-payment. Where can I get help, so I can get Reclast?”
The drug manufacturers do offer patient assistance programs but the financial requirements are pretty rigid. Your income must be substantially low to qualify and many don’t qualify. If you don’t qualify for the patient assistance programs, what other options are left? There are other patient assistance programs besides that offered by the manufacturers of these drugs. I’ll list all that I found at the end of this article, so take a look and see if any of these can help you.
It’s very difficult if you have a medical problem but the only treatment is out of your financial reach. As you can see, our members are facing the same problems, and feel like they have no options. For the uninsured and underinsured, life with a medical problem is really tough. What can you do, where can you turn? One idea, I’ve thought of is to talk to your health care provider and see if there is a discount for cash payments. You may also be able to set up a payment plan, where you make monthly payments on your medications or put the charges on a medical credit card. I don’t have very good dental insurance and if it wasn’t for my providers help, with monthly payments provided to me without interest, I wouldn’t be able to pay for the expensive procedures I feel I must have since I don’t want to lose my teeth. I also use a medical credit card that has different plans where you can pay it off in 36, 24, 12 and 6 months without interest. This makes it a bit easier on the pocket book, and I know I couldn’t make it or have my dental work done without it. This is for dental work, that isn’t covered by my HMO, but almost all doctors and hospitals accept these, so look into them. One that is good is Care Credit. It covers things like medications, hearing aids (something Medicare doesn’t cover) dental, eye glasses and veterinarian bills. It has been a life saver for me since I’ve needed quite expensive work done recently and it’s not over yet. At least I can budget my payments and not have to come up with the total cost up-front.
Some of our members are on Medicare Part D plans, and each of these is very different in what the cover. Some cover osteoporosis medications and some only cover generics for these drugs; my husband’s only covers generic, so if he needs a brand name drug he either has to pay retail or go without which can be very dangerous for him, depending on the medication and how essential it is to his health.
Unfortunately only four of the osteoporosis medications come in generic since they are no longer on a drug manufacturer’s patent. Fosamax ®, Boniva** ®**, Calcitonin** ®** and Hormone Replacement Therapy (HRT) come in generic.
If you’ve already had a fracture, your doctor will probably recommend Forteo ® or Prolia ®; both of these drugs are expensive, and Part D plans cover Prolia, in some instances, and Forteo is rarely covered due to the retail cost of $1,300.00 a month. Forteo and Prolia are not available in generic, so if your insurance doesn’t cover either, then the cost would be $825.00 twice yearly for Prolia and $1,300.00 a month for Forteo.
Most patients can’t afford the price tag of Forteo, so they look to patient assistance. Will they qualify, who knows till they look at the qualifications? The future is looking pretty bleak with osteoporosis drugs. Another option for Forteo is to ask your doctor for samples. Forteo comes in a pre-metered dose pen of 28 days, so the sample is a full month’s supply not a few days’ worth, like most samples received at a doctor’s office. If you are trying to pay for Forteo and have run out of options for payment, see if you doctor will supplement your supply, where they provide some full-month supply pens. I did this; and my doctor was happy to oblige, because I had finished a year on Forteo and the second year my insurance copay rose to $200.00 a month, but that was 4 years ago and the cost has doubled since then making it even more difficult to afford. Remember that these pens have a shelf life of one year and if the doctor doesn’t give away the samples, they must throw them away; what a waste of a precious drug, so don’t be shy ask for help, I bet you’ll find your doctor is happy to help to keep you on the treatment for the full 24 months (full treatment course for Forteo).
Most Medicare Part D plans pay for generics and not brand name drugs, so those with this type of insurance have to choose the generic form that’s available, and they could have pre-existing problems with this particular generic drug. Some generics have innocuous addictive’s, but some of us are allergic to these things that are added and can’t take them. If this is the case it may help to have your doctor check the "do not substitute" box on the prescription.
If you want to take a drug that isn’t covered, then you may have to pay the retail price, if patient assistance or a medical credit card doesn’t work.
We are also seeing changes in insurance prescription formularies (companies’ covered drugs) due to the high cost of prescription medications. Now that four of the osteoporosis treatments (Alendronate/Fosamax, Ibandronate /Boniva, Calcitonin/Miacalcin and Hormone Replacement Therapy/HRT) are available in generic, this is prompting the insurance companies to push the cheaper medication and not cover the brand names. If your insurance covers generics then you’ll be expected to take one of these since that’s the only option, if you can’t afford the retail price on your own.
Good luck finding a solution to this difficult issue of affording the medications you need.
Below are links to all the manufacturers of osteoporosis medications and the patient assistant programs I’m aware of.
See the National Osteoporosis Foundations NEW Prescription Savings Card https://www.nof.org/rxsavings
Eli Lily Patient Assistance Program (** Forteo ® and Evista ®**)
Primus Patient Assistance Program (** Fosteum
Proctor and Gamble Patient Assistance (** Actonel
Novartis Patient Assistance Program (** Reclast
Roche Patient Assistance Program (** Boniva
Amgen Patient Assistance Program (** Prolia ®**)
Patient Assistance Programs
Patient Assistance Programs
Pam wrote for HealthCentral as a patient expert for Osteoporosis.