Tips for Lowering Medicine Costs
Medications are often a major expense for people diagnosed with cancer. A good first step is to take a look at your health insurance plan’s prescription coverage to see what’s covered and what’s not — and how much you can expect to pay out of pocket. If costs are a concern, ask for help from your health insurance plan or a patient financial counselor at your hospital or cancer center. The following strategies also may help:
Ask your doctor or pharmacist about generic medicines. Generic medicines are usually less expensive than brand-name medicines. There are some generic options for certain types of chemotherapy; hormonal therapies such as tamoxifen and aromatase inhibitors; and bone-strengthening medications such as bisphosphonates. Ask about generic versions of medicines used to treat side effects such as pain and nausea. Depending on your situation, you may be able to take the generic rather than the brand-name medicines.
Ask your doctor for samples of medicines prescribed to you. Samples can help you avoid paying for a full prescription that you might not be able to take if you have side effects and have to switch to a different prescription. Keep in mind that samples might not be available for all medicines. Doctors cannot give out samples of narcotic analgesics for pain (also called opioids, such as morphine, codeine, or oxycodone). To keep costs down, you also can ask your doctor to give you a partial prescription so you can make sure the medicine works for you before paying for a full supply.
Ask if the way medicine is given affects your cost. Oral chemotherapy medicines — pills taken by mouth — are more convenient, but they tend to be pricier than medicines given intravenously (IV). Additionally, your health plan may not reimburse medicine you take at home or in a doctor’s office the same way it reimburses a hospital-based treatment. Your health plan may cover various types of medicines differently, depending on how they are given (pills, patches, IV) and depending on their dose. You may need to weigh out-of-pocket costs versus convenience as you make decisions about the medicines you need.
Shop around. Call the pharmacies in your area to check how much the medicines prescribed to you cost. You may find that some larger stores have lower prices for commonly prescribed pain medicines and antibiotics. Ask if your health insurance plan offers a mail-order prescription medication option that may cut down on your costs.
Talk your pharmacist. If your health plan does not cover the medicine prescribed to you, your pharmacist may be able to suggest an alternative medicine that works just as well — and is covered.
In general, don’t order medicine from online pharmacies. Although some online pharmacies offer low prices, the U.S. Food and Drug Administration (FDA) advises people not to buy medicine online. Some online pharmacies may not be licensed. Some online pharmacies may sell medicine that isn’t FDA-approved (considered counterfeit). Counterfeit medicines look exactly like real FDA-approved medicines but are impure — that is, they contain incorrect or potentially harmful ingredients. If an online pharmacy is your only option, make sure the website has the National Association of Boards of Pharmacy’s Verified Internet Pharmacy Practice Sites Seal, also known as the VIPPS Seal. This seal means the online pharmacy applies and meets state licensure requirements and other VIPPS criteria.
Medicine assistance programs
Many pharmaceutical companies offer patient assistant programs to help people get the medicine they need at a reduced cost or, in some cases, free. Some pharmaceutical companies also offer to help you get coverage for your medicine through your health insurance company. There are also organizations that offer to help pay for medicines and other treatments for people in need. Here are some of the most well-known programs and organizations. You may need to meet certain age or income requirements to enroll in some of these programs. Talk to your doctor’s office, health insurance company, or hospital social worker to learn about local programs in your area that may be able to help.
|Drug Name||Drug Maker||Assistance Programs|
Amgen Assist 360
Amgen First Step Program
*Assistance with deductible, co-insurance, or co-payment for eligible commercially insured patients
Safety Net Foundation
*For those with limited or no drug coverage
Bristol Myers Squibb
Bristol Myers Squibb Access Support
Lilly Cares Foundation
Lilly Oncology Support Center
Eisai Reimbursement Resources
*May provide co-pay/coinsurance assistance or no-cost medication
Genentech Access Solutions
Johnson & Johnson Patient Assistance Foundation
Patient Rx Solutions
Novartis Patient Assistance Foundation
Patient Assistance Now
Novartis Oncology Universal Co-pay Program
Access + Support
Other organizations that may help you pay for medications
AARP offers discounts on prescriptions to members.
Family Caregiver Alliance helps older people and their families find public and private programs that can help them pay for medicines and other needs. The site is a service of the National Council on Aging.
CancerCare Co-Payment Assistance Foundation, 1-866-552-6729, offers financial assistance with health insurance co-pays and medicine costs. The foundation is affiliated with CancerCare, an organization that offers support services for people diagnosed with cancer.
HealthWell Foundation offers financial assistance with medication costs, health insurance co-pays, and premiums for people diagnosed with specific diseases, including breast cancer.
NeedyMeds, 1-800-503-6897, is an organization that offers information on a number of programs that help pay for medicines. NeedyMeds only provides information — the organization doesn’t help with specific problems.
The Partnership for Prescription Assistance, 1-888-477-2669, helps people without prescription coverage find assistance programs to help them get the medicines they need.
The Patient Access Network Foundation, 1-866-316-7263, offers financial assistance to people who can’t pay for treatment. To be eligible for the breast cancer fund, you must have health insurance.
Patient Advocate Foundation Co-Pay Relief, 1-866-512-3861, helps people with health insurance pay for the medicines and treatments they need.
Here we discuss various U.S.-based resources and U.S. regulations. Other countries may have different laws regulating health insurance coverage and hospital operations. If you live outside the United States, ask your doctor about resources in your country.
— Last updated on January 21, 2022, 9:22 PM