Medications are often a major expense for people with cancer. First, make sure you take a look at your 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 you’re having trouble, ask for help from your insurance plan or a patient financial counselor at your hospital or cancer center. These strategies also may help:
- Ask your doctor or pharmacist about generic medicines. Generic medicines are usually less expensive than brand name medications. 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 generics for medications 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 any medicines you're prescribed. Keep in mind that samples might not be available for all medicines. But if you take a sample medication and have side effects that are difficult to manage, you won't have to pay the cost of a full prescription if you switch. Note: Doctors cannot give out samples of narcotic analgesics for pain (also called opioids, such as morphine, codeine, or oxycodone). To keep costs down, ask for just part of a prescription to make sure that the medication works for you before paying for a full supply.
- Ask if the form of the medication affects your cost. Oral chemotherapy medications — taken by mouth in pill form — are more convenient, but they tend to be pricier than medications given intravenously (IV). Also, a medication taken at home or given in a physician’s office might not be reimbursed in the same way that a hospital-based treatment is. Different forms of medication (pill, patch, IV) and different doses may be covered differently. You may need to weigh out-of-pocket cost versus convenience as you make decisions about medications.
- Shop around. Call the pharmacies in your area to check the prices of the medicines you've been prescribed. You may find that some larger stores have lower prices for commonly prescribed pain medicines and antibiotics. Ask if your insurance plan offers a mail-order prescription medication option that might cut down on your costs.
- If a medication isn’t covered, ask your pharmacist about alternatives. He or she may be able to suggest another medication that does the same thing as the one your doctor recommended — and is covered.
- In general, don't order medicines from online pharmacies. While some online pharmacies may 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 is unapproved, or "counterfeit" medicines. Counterfeit medicines may look exactly like the real FDA-approved medication, but are impure (contain ingredients other than the medicine) so the dosage isn't what's listed on the label. If there is no other way to afford your medicine than through an online pharmacy, make sure the web site 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 have set up programs to help people get the medicine they need at a reduced cost, or no cost in some cases. Some offer assistance with getting medications covered through your insurance company. Other organizations offer help paying for medicines and other treatments to people in need. Below 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 Program(s)|
AbbVie Patient Assistance Foundation
Amgen Assist 360
Safety Net Foundation
*For those with limited or no drug coverage
AstraZeneca Affordability Programs
|Bristol Myers Squibb||
Celgene Patient Support
Eisai Reimbursement Resources
*May provide co-pay/co-insurance assistance or no-cost medication
(trastuzumab and hyaluronidase-oysk)
(T-DM1 or ado-trastuzumab emtansine)
(pertuzumab, trastuzumab, and hyaluronidase-zzxf)
Janssen Prescription Assistance
Johnson & Johnson Patient Assistance Foundation
Patient Rx Solutions
(ribociclib; formerly LEE011)
Patient Assistance Foundation
Patient Assistance Now
Universal Co-Pay Program
Access + Support
- AARP offers discounts on prescriptions to members.
- BenefitsCheckUp helps people 55 and older 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 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, 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 Assistance Program, 1-866-512-3861, helps people with insurance pay for the medicines and treatments they need.
The resources listed in this section are based in the United States and the regulations mentioned are U.S. regulations. Other countries may have different laws regulating insurance coverage and hospital operations. If you live outside the United States, ask your doctor about resources in your country.
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