Financial Toxicity - The Financial Burden Of Medications & What Patients Can Do

People also experience financial toxicity not just from the cost of treatment but from the exorbitant price of prescription drugs. (Note: if you’re in a place of financial toxicity and want to know what to do, I suggest reading my other post or if you’re looking to  avoid it, here’s my post about that) Even medications for common conditions are unbelievably expensive. The cash price for Zolpidem (generic version of Ambien used to treat insomnia) averages $296 a month and the average monthly cost for Tadalafil (generic version of Cialis used to treat erectile dysfunction) is $518. If that makes you mad, get ready to be livid because the cancer medications Keytruda and Ibrutinib cash monthly prices are $14,529 and $16,734. That’s not even the most expensive cancer medication! That distinction goes to Kimmtrak which costs $81,293 monthly or $975,520 annually. Affording prescription drug costs can be a tremendous struggle but there are several strategies that we at Tikkun Patient Advocates utilize and you might find helpful.

As always, one of the first steps is to communicate openly with your healthcare providers about the cost of your medications and the strain it is causing you and your family. Simply put, they don’t know what they don’t know and there are things they can do. The first is asking your doctor if there’s a generic version of the medication they are prescribing and asking them to fill that instead. Generic medications are exactly the same as brand-named but will always be significantly cheaper. If there isn’t, you might want to ask your doctor if there’s an appropriate medication that’s similar for you to take instead. When a medication is so unbelievably expensive it’s often because it’s not on your prescription drug plan’s “formulary” – is a list of all the medications they will pay for. They believe that another medication will work just as well for your condition and will pay for that one instead. Just by asking your doctor, you could save a lot of money but if the medication is medically necessary, your doctor will have to write to the insurance for a “formulary exception” to get it covered.

If your formulary exception is denied, there’s still some options for you to consider. Pharmaceutical companies often provide savings cards, discount programs, or patient assistance programs that can significantly lower out-of-pocket expenses for eligible individuals. These programs vary depending on the medication and manufacturer, so you really need to be proactive and do your own research. Another option might also be changing your health insurance plan to one that covers the medication. This would make sense if it’s a medication that you’ll be on for a while but keep in mind that you can only change plans during open enrollment which is generally towards the end of the calendar year or if you have a qualifying life event. If this is something you’re interested in, we strongly suggest making sure the medication you’re switching for is indeed covered and that you’re able to change plans. Another thing to be aware of when shopping for health insurance is that some health plans offer mail-order pharmacy services or preferred pharmacies and these can significantly reduce your medication costs.

Leveraging the power of technology is also a great strategy. Numerous apps and websites, such as GoodRx, can help patients compare prices and find the best deals on their prescription medications. These platforms search for pharmacies offering lower prices in your area and empower you with the information so you can make an informed decision. Accredited online pharmacies are also an option and they generally provide medications at more competitive prices but, akin to anything you’re buying online, you need to be careful. You’ll want to confirm the legitimacy of the pharmacy and read other customer’s reviews before making any purchases.

At the end of the day, what patients have to pay for their medications can be insanely high. Even being in a position where patients need to decide between their medication or paying their bills is unfair. Hopefully some of these strategies and techniques can alleviate some of that stress but if you find that you have questions or need any help, Tikkun Patient Advocates is always here for you.