Challenge the High Cost of Your Prescription Meds!

One of my pet peeves is the cost of prescription medications. Last year I did a piece on the cost of Eliquis, which my husband has to take for atrial fibrillation. At the time, his insurance company made a (probably financial) decision that they would no longer cover Eliquis. He would have to switch to Coumadin, another anticoagulant that requires frequent blood tests but is significantly cheaper. I did my homework (hours and hours) and discovered that the “gold standard” to treat a-fib is with Eliquis; I wrote a lengthy letter to the insurance company. Fortunately, his doctor was wonderful and willing to spend the time to get this accomplished. They put the letter on their letterhead, and the medication was allowed.

Fast forward to retirement, where there are no good options unless you make under $59,000 as a couple for the year or have government insurance. Regular Medicare does not cover Eliquis and can cost up to $500 a month! And then a person falls into the donut hole, which means more money out of pocket. This is why many people stop taking their life saving drugs.

I am a tenacious advocate and left no stone unturned. I found out your provider can contact your insurance company and change the “tier” of the medication. Different medications have different tiers. Typically tiers 1 and 2 are the least expensive, often generics. Tier 3 is a little higher and tier 4 even higher, and it would have cost us $500 with his insurance!

We were able to get an adjustment from tier 4 to tier 3, and we will be paying $44 vs. $500! There are almost always options to get a cheaper medication cost, and you need to follow through and work with your provider, insurance company, and the medication maker. It takes time (I probably spent about 8-10 hours), but it is worth it. And if you have problems doing it, ask a patient advocate to help. It will be well worth the cost!