Dan Weissmann
About 3 in 10 adults reported not taking their medicines as prescribed in some unspecified time in the future between July 2022 and July 2023 due to the price, in keeping with a KFF survey. So, this 12 months, “An Arm and a Leg” requested listeners: What methods have you ever used whenever you’ve been struck by pharmacy sticker shock?
Dozens of listeners responded with their tales, together with Bob, who’s being recognized solely by his first title to protect his household’s privateness and whose daughter has epilepsy. When Bob modified jobs, the value tag for his daughter’s remedy went by way of the roof. In this primary installment of a two-part sequence, “An Arm and a Leg” shares classes from Bob’s expertise navigating a maze of pharmacies and insurance coverage firms to get his daughter the medication she wants.
Dan Weissmann
Host and producer of “An Arm and a Leg.” Previously, Dan was a workers reporter for Marketplace and Chicago’s WBEZ. His work additionally seems on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.
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Emily Pisacreta
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Claire Davenport
Producer
Adam Raymonda
Audio wizard
Ellen Weiss
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Transcript: The Prescription Drug Playbook, Part I
Note: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can comprise errors. Please use the transcript as a device however verify the corresponding audio earlier than quoting the podcast.
Dan: Hey there.
When I inform associates that we’ve been engaged on a sequence about the right way to pay much less for prescribed drugs, I discover myself telling them a few man named Cole Schmidtknecht.
In January of final 12 months, Cole went to a Walgreens in Appleton, Wisconsin, to get refills on the remedy he used to manage his bronchial asthma.
He’d been taking it for years, and he anticipated to pay about seventy bucks.
But — that is all in keeping with a lawsuit filed by Cole’s people– the pharmacy stated his insurance coverage didn’t cowl his medication anymore. He’d must pay greater than 500 {dollars}.
He left with out it.
A couple of days later, he had a large bronchial asthma assault. He died after just a few days on life help. He was 22 years outdated.
In their lawsuit, Cole’s people say the pharmacist at Walgreens might’ve informed him proper then and there about comparable medicine his insurance coverage would’ve paid for.
This is the sort of info all of us want, all deserve.
In surveys, 1 / 4 of Americans say they’ve skipped taking meds prior to now 12 months due to price.
And possibly we will put slightly dent in that.
Because there are literally plenty of issues to know, and plenty of issues– plenty of methods we will attempt when it seems like our medication is gonna price an arm and a leg.
Over the previous couple of months, you’ve truly been serving to us study extra of those methods, and right here we’re gonna begin tying these classes collectively.
Back in February, we requested you, our listeners, to inform us the way you’ve managed when your prescriptions obtained actually costly.
And we heard again from a LOT of you.
Person 1: We went to go choose up the prescription and we had been like, holy moly, that’s so costly.
Person 2: We’ve been given estimates of $30,000 a dose
Person 3: The pharmacist would burst out laughing each time I confirmed up
Dan: And … you informed us what you probably did subsequent. The methods you realized for combating again, and typically profitable.
A variety of these methods, we knew about. Some, we had been like, whoa, that’s a brand new one on us!
I imply, with all of this, there’s no assure that your specific downside has a very good answer.
Our complete system sucks. These are patches, workarounds.
Cole’s dad– he now works full time attempting to alter the entire system of how we get charged for meds. Which is a should– and is gonna be a protracted haul.
But within the meantime, these patches and workarounds — truthfully, they will actually assist lots of people.
So right here’s what we’re gonna do.
We’re gonna break down what we’ve realized into chunks you’ll be able to digest, and share. We’re gonna take TWO episodes of this present to do it.
And we’re NOT anticipating you to take out a pen and paper: We’re gonna share every little thing in writing, in our First Aid Kit publication. Including stuff that doesn’t match on the podcast.
It’ll take 4 installments. I’m telling you, there’s so much.
Meanwhile, we’re beginning right here with one man’s story– a listener named Bob.
Bob’s journey goes to assist us present you — nicely, the journey. How the trial and error works. The obstacles.
And we’ll present you the methods Bob labored to get by way of these obstacles. Including a device he developed, that we’re gonna share with you.
And I’ve obtained some assist telling Bob’s story. Our producer Claire Davenport did a lot of the reporting for this episode. Hey, Claire!
Claire: Hi, Dan!
Dan: You’re gonna inform us Bob’s story, after which at some factors, we’ll zoom out — like tour guides, mentioning the large classes
Claire: Yep! I’m tremendous excited to get into it.
Dan: Let’s go.
This is An Arm and a Leg, a present about why well being care prices so freaking a lot, and what we will possibly do about it. I’m Dan Weissmann — I’m a reporter, and I like a problem. So the job we’ve chosen on this present is to take one of the crucial enraging, terrifying, miserable elements of American life, and produce you one thing entertaining, empowering, and helpful.
Okay Claire, the place ought to we begin with Bob’s story?
Claire: First, let’s meet Bob. He’s obtained so much occurring…
Bob: Between me and my spouse, we now have 5 youngsters and uh, three canines, and two cats and two lizards.
Claire: Did you ever anticipate you’d be a dad to so many, Bob: Nobody plans to have many youngsters, Claire.
Claire: By the way in which, Bob requested us simply to make use of his first title for privateness causes. But we’ve checked out his story — he despatched us a lot of documentation.
Bob’s journey right here begins in 2019 — the primary day of highschool for his daughter, Mary.
After she obtained dwelling, he needed to listen to the way it went, so he referred to as her.
Bob: We had been speaking and, I might say she’s being slightly spacey, however, uh, speaking to a 14-year-old on a cellular phone, proper?
And, and I’ll always remember this, she, we had been speaking and impulsively she stated, the ceiling seems so humorous.
And then, um, after which she was form of gone.
Claire: At first, he assumed Mary had simply set the cellphone down — possibly to speak with one in every of her sisters.
Bob: I textual content her mother and say, Hey, I used to be speaking to our oldest daughter, and, uh, she simply form of disappeared now she’s not answering the cellphone. Can you go verify on her?
And I nonetheless get even choked up speaking about this. But, I get a textual content again in about two minutes saying she’s unconscious.
Claire: They find yourself calling an ambulance. Bob is scared.
Bob: All sorts of ideas had been operating by way of my thoughts by way of what might probably have occurred right here. Epilepsy was not one in every of them.
Claire: Epilepsy. It’s a situation that causes seizures. And Mary was having one whereas her dad was on the cellphone together with her.
Mary and her people labored with a pediatric neurologist. They began attempting out totally different drugs and dosages.
Bob: We had been informed, we’re going to determine what the proper drugs are for her. This is gonna be a course of.
Claire: And it was. It took years of trial and error: they needed to experiment with totally different drug mixtures.
Finally they landed on the right combination. That combine included a drug referred to as Clobazam. Bob: And that gave the impression to be the magic bullet
Claire: A magic bullet with an inexpensive price ticket.
Bob: the three medicine she was on had been nicely beneath 100 {dollars} for all three of them collectively
and she or he went over a 12 months and not using a seizure.
(beat)
Bob: And then I modified jobs.
Claire: Which had an sudden consequence. As Bob realized when it was time to refill Mary’s prescription for Clobazam.
Bob was used to paying round 15 {dollars}.
Bob: This time the pharmacist comes out and says, Hey, your, your Clobazam is gonna be $500.
Claire: Ok, so…Dan, let’s take a step again. Bob modified jobs, and abruptly Mary’s Clobazam is $500. Because…
Dan: Bob’s new job meant… a brand new insurance coverage plan for the household. And…
Claire: Every insurance coverage plan has its personal record of how a lot you pay for which medicine. And which medicine they don’t cowl in any respect. That record known as “the formulary.”
Dan: That record, that formulary, is predicated partially on enterprise offers that plans and drug-makers hash out behind closed doorways.
Claire: So whenever you change jobs, change insurance coverage: the distinction between what’s on one formulary and what’s on the following: It may be…
Dan: unpredictable at greatest.
And even in the event you don’t change jobs, your job might change your insurance coverage plan. That occurs so much.
Claire: And even when your insurance coverage plan doesn’t change, that plan’s formulary can change from 12 months to 12 months.
Dan: So, Claire, this looks like the primary massive lesson from Bob’s story — the primary massive impediment: The deal can change on you. And MAYBE, on this new deal, your insurance coverage provides one other drug they are saying is simply pretty much as good.
But it might not be simply pretty much as good for YOU. That’s a factor.
Claire: And it was positively a factor for Bob and his daughter Mary. Remember, they’d spent YEARS of trial and error, discovering the right routine.
Just switching to no matter random factor the insurance coverage firm approves, that’s not on the desk.
So first, Bob thinks, hey possibly there was just a few sort of mistake right here. New insurance coverage firm, proper? Maybe the pharmacy obtained confused. Bob calls his insurance coverage simply to ask, and so they’re like:
Bob: Oh, nicely that remedy, , is simply lined for a sure sort of, of epilepsy
Claire: Which isn’t the kind they assume Mary has. They’re not gonna cowl it. So, now we now have arrived on the level the place Bob busts out his first massive technique: Haggling along with his insurance coverage. They’ve stated “no,” however that doesn’t imply he has to just accept this as their remaining reply.
Dan: Yep, we heard from so many individuals — have heard over time: This is a complete dance, a complete battle.
Claire: Yep, and Bob’s gonna take us by way of it. In reality, on this exact same cellphone name the place his insurance coverage firm stated they wouldn’t cowl Mary’s Clobazam, they principally invited him to this dance. They stated:
Bob: Well, there’s a previous authorization that may be stuffed out. We’ll ship that to your physician.
Dan: There’s a previous authorization for that! We’ll ship that to your physician!” The method Bob says that, it sounds just like the insurance coverage particular person was so cheerful. Making issues sound really easy.
But prior authorization…
Claire: That’s a hurdle, a hoop for Bob — and Mary’s physician — to leap by way of.
Dan: This will probably be acquainted to plenty of people already, however: Prior authorization… PRIOR:
Claire: Before the insurance coverage firm can pay for Mary’s Clobazam, Dan: They must AUTHORIZE it.
Claire: her physician has to make a case that she wants this specific therapy — and the insurance coverage firm has to resolve the argument is sweet sufficient.
Dan: We see it on a regular basis.
Claire: Bob isn’t thrilled by this requirement.
Bob: Seems pointless. This is a, you realize, board licensed pediatric neurologist who’s been seeing this affected person for years.
Claire: And who took her by way of a complete lengthy trial-and-error course of to search out the proper meds.
Dan: Because of Bob’s confidentiality, his insurance coverage firm stated they couldn’t reply on to his story — honest sufficient. But plenty of the time, Insurance firms say: Hey, we’re simply discouraging waste with these prior authorizations! Sometimes docs just do prescribe an costly factor, when one thing cheaper could be simply pretty much as good. Okay.
But plenty of sufferers say, like Bob would: My docs and I had already DONE all this checking.
Claire: Bob will get type despatched in, however now he’s obtained one other downside. The insurance coverage firm wants time to judge the prior authorization. And Mary wants her medicine proper now.
Bob: She begins to panic slightly little bit of like, Hey, I, I want my remedy. If I miss a pair doses, I might have a seizure.
Dan: That’s a foul downside.
Claire: Luckily: Bob discovered a method to get Mary’s Clobazam for lower than 5 hundred {dollars} every week. We’ll get into that slightly later.
But for now, simply to notice: It’s fortunate he discovered that workaround. Because when Bob calls to verify on the prior authorization– PA for brief– Well, right here’s how he says the dialog went…
Bob: ‘Yes, we got the PA information. It was denied.’
‘It was denied? What, uh, why was it denied?’
‘Oh, well, again, it looks like it’s solely accredited for this one specific sort of epilepsy.’
Claire: Which was simply what they’d stated earlier than. Bob will get able to enchantment.
And he says that is attending to him. When we talked, he talked about a lesson from this present:
Bob: I believe you guys advocate this of like not shedding your cool with the customer support individuals, within the insurance coverage firms.
Dan: We do. Everybody says: It actually helps.
Claire: And everyone is aware of. It’s not truly all the time doable. Here’s what occurred the following time Bob calls his insurance coverage.
Bob: They requested me, oh, how’s your daughter doing? And I simply bear in mind saying like, you don’t care how my daughter’s doing. She’s terrified. She’s gonna be strolling to class and have a seizure as a result of she doesn’t have the remedy. So don’t give me this BS about how’s my daughter doing.
Dan: Bob looks like a reasonably level-headed man.
Also — we’ve sort of withheld this till now– however Claire, you informed me Bob works in well being care, so he is aware of slightly extra about this world than most of us do. Insurance, appeals.
He’s obtained the benefit, by way of maintaining his cool, of not being in completely international terrain.
Claire: Yep, and he says he recovered his cool fairly shortly.
Bob: I pulled again at once I realized what I used to be doing. Like this isn’t this particular person’s fault. They’re simply most likely studying a script.
Dan: But that is sort of the lesson right here: No matter what sort of benefits you have got, these things is so irritating. Anybody can lose their cool. The key — and possibly we must always do a complete present on this — is recovering. Because you’re gonna must stand up and go once more.
Claire: Yeah, and we’re simply attending to the most irritating half. Dan: Right.
Claire: After greater than a month– and two rounds of appeals– Bob says Mary’s Clobazam lastly will get accredited.
Dan: And that is the irritating half as a result of…
Claire: Insurance will cowl it now. But they inform him his share goes to be $150. Remember, Bob stated beneath his outdated insurance coverage, it used to solely price $15.
Bob: So 10 occasions the value now, plus the value you realize, of the opposite drugs she’s on.
Dan: Yep. All this ready, all this combating, every little thing. And it’s ten occasions greater than he used to pay beneath his outdated insurance coverage.
Claire: It’s much less unhealthy– this insurance coverage initially was gonna make him pay greater than 500 bucks. But yeah. Not nice.
Dan: But Claire: this isn’t the top of Bob’s story, proper?
Claire: Not even shut.
Bob: What this sparked us to do is to have a look at, nicely okay, if it’s not going to get accredited, what are the opposite choices?
Claire: We’ll get into these choices– after the break.
Dan:This episode of An Arm and a Leg is produced in partnership with KFF Health News. That’s a nonprofit newsroom masking well being points in America. Their reporters win every kind of awards yearly. We are honored to work with them.
So, Bob has labored the technique of Haggling With His Insurance. And he received. Kind of. Except that profitable nonetheless leaves him paying ten occasions greater than he used to.
Claire: Yes, and now he’s going to work a complete totally different technique: Ignoring his insurance coverage. Because there can be higher offers elsewhere. Bob begins with GoodRx.
Dan: Lots of individuals comprehend it — it’s an internet site the place you inform them what drug you want, and so they’ll present you offers — reductions — at native pharmacies.
Which doesn’t all the time work. Saving 50 % on a thousand greenback drug doesn’t make it inexpensive. I do know individuals who get mad whenever you point out it.
Claire: Bob says he obtained mad due to who really helpful it to him: a rep from his insurance coverage firm.
Bob: Like you’re my insurance coverage firm. Why? You’re, that’s what I pay you for.
Claire: Right? he pays them premiums so he pays much less for well being care, together with medication. But he didn’t write it off. And he says now, it was truly helpful: though he knew about GoodRx earlier than, he wouldn’t have thought to go there.
Bob: like I nearly, and that is gonna sound loopy, however I nearly considered GoodRx as like Medicaid. Like, I believe I considered it as like, oh, nicely that’s what you utilize in the event you don’t have insurance coverage.
Dan: Interesting! And in a single sense, he wasn’t mistaken: When you utilize a GoodRx low cost, you’ll be able to’t use your insurance coverage too. But it seems, even when you have got insurance coverage, GoodRx may be value taking a look at.
Claire: Yes, and right here’s what makes Bob’s story stand out — the rationale we needed to actually dig in. It’s what he did subsequent. Because he didn’t simply take a look at GoodRx. He began exploring a complete world of choices. Actually, worlds.
One is the world of websites LIKE GoodRx.
Dan: Ooh, I’m googling “sites like GoodRx” — right here’s SingleCare, RxSaver, BuzzRx…
Claire: Yep, and for any given drug, every of those websites might present you totally different costs. So now that he was taking a look at this world, he began mapping it.
Bob: I created this spreadsheet that had every of these choices, the totally different drugs after which the totally different pharmacies and the place we might sort of get the most effective worth for issues.
Claire: And: Once Bob began taking a look at THIS outside-insurance world, began exploring others. Like Cost Plus Drugs.
Bob: And –What was actually form of eye-opening to me is that they did so a lot better than our insurance coverage firm did.
Dan: We ought to actually discuss Mark Cuban Cost Plus Drugs, to make use of its full title. It’s fairly totally different.
Claire: Right. The superstar proprietor.
Dan: Mark Cuban is principally well-known for being wealthy. Like he owns the Dallas Mavericks basketball crew.
Claire: And he’s spent 15 years on the fact present Shark Tank. [THEME]
Dan: It’s like American Idol for startups. People pitch their enterprise to traders who would possibly provide to purchase in, on digital camera.
TV announcer: Mark Cuban has simply made the biggest provide in Shark Tank historical past.
Mark Cuban: Lemme ask you a query. If I supplied you $30 million for the corporate, would you are taking it?
Claire: All of that, however the superstar issue isn’t actually what makes Cost Plus totally different: The firm buys meds direct from producers, and provides 15 % to their wholesale price.
Dan: Plus delivery charges, and 5 bucks for “pharmacy labor”. Claire: Bob added CostPlus to his spreadsheet. And he appreciated what he noticed. Bob: It’s very clear and tremendous low price.
Claire: He requested Mary’s docs to switch two of Mary’s prescriptions.
Dan: But not all of them. Cost Plus doesn’t carry every little thing. For one factor, they largely solely carry generic medicine.
Claire: And — what issues in Bob’s case: they don’t carry managed substances. Nobody sells them on-line as a result of it’s unlawful to ship them. And Mary’s Clobazam? It’s a sort of managed substance: They’re referred to as Benzos.
Dan: Like Valium and Xanax.
Claire: So for Clobazam, the most effective worth he can discover is 85 bucks, utilizing GoodRx at Walmart.
Dan: A LOT lower than his insurance coverage was gonna have him pay. go spreadsheet! Head to WalMart, use GoodRx there.
Claire: Just one factor: Mary’s off at school now, and there’s no Walmart proper close by. And Mary, doesn’t drive.
Bob: Well, she has epilepsy. She can’t have a driver’s license, so it’s uh, she will’t drive wherever. Right? We had a Walmart close to our home at dwelling. I’m two and a half hours away from her.
Claire: And he says he made the drive.
Dan: Dad of the last decade. For ALL of this. Bob fought down the insurance coverage firms. He shopped round. He made the spreadsheets. And he made a bunch of spherical journeys to his daughter’s school.
Claire: Yeah, Bob guidelines. But he’s not precisely blissful about all of it.
Bob: I pay an insurance coverage firm each month outta my paycheck for prescription drug profit that I don’t really feel like I get, proper? Like I’m having to go outdoors of that with a view to get them the drugs which are nothing particular. Like, clobazam has been available on the market since just like the seventies.
Dan: Yeah, honest.
Claire: But he could also be sport to take the win on that Dad of the Decade award.
Bob: Would say I did a powerful job of, you realize, staying, staying calm, and hiding that stress from Mary
Mary: I assumed he was gonna determine it out. Um.. [laughs] Bob: Total confidence in me, proper? [laughs]
Dan: That’s Mary?
Claire: That’s her.
Dan: OK, so let’s evaluation these classes: Yes, you’ll be able to battle your insurance coverage, however it’s possible you’ll get a greater deal going outdoors of it. All of which suck — this was a LOT of labor, and never a complete victory — however is best than NOT understanding any of this.
Claire: Yes. And this story finally ends up going full circle. Back to the primary lesson. The deal can change on you. For worse. Or for higher.
Bob modified jobs once more lately — so, new insurance coverage.
And truly, it’s good this time! Under Bob’s new insurance coverage, Mary’s clobazam is … again to fifteen {dollars}.
Which she realized when she went to choose it up lately.
Mary: I used to be like, that is superb. Definitely a weight lifted off my chest once I noticed a two digit quantity.
Dan: And talking of how the deal can change on you… this jogs my memory: went taking a look at GoodRx lately, and noticed a brand new worth for Mary’s Clobazam there, too.
Claire: Yes. The lowest worth on GoodRx is now: Thirty {dollars}, at a CVS she will stroll to.
I confirmed the present GoodRx costs to Bob and Mary, and what struck Mary at first was this: how totally different the costs at totally different pharmacies had been.
GoodRx stated CVS had Clobazam for 30 {dollars} however…
Mary: It stated Walgreens was like over $300.over. It was like 300 after which every little thing else is between 25 and 35, possibly 40, however I don’t perceive that.
Dan: I KNOW! Man, I had this actual expertise just a few years in the past. I used to be like, WHY ARE THESE SO DIFFERENT?
I ended up studying about firms referred to as pharmacy profit managers or PBMs. They’re those that truly resolve which medicine our insurance coverage covers, and the way a lot we pay for them.
We did a WHOLE episode about them (it was SOO sophisticated, however I realized an enormous quantity)
Claire: So we’re NOT gonna get into right here, however we’ll go away a hyperlink within the present notes in case individuals wish to nerd out.
Because at this time we’re simply taking a look at the right way to get issues to work higher for YOU.
So: Mary was curious concerning the 300 Walgreens worth from GoodRx. And by the way in which, she’s additionally livid with the entire system.
But right here’s one factor she was submitting away: She might now use GoodRx to get Clobazam for 30 {dollars} at CVS.
Mary: It was not like {that a} couple years in the past. And it’s reassuring to know, like, if I present up and it’s, you realize, $150, there are locations that will have a worth I might truly afford.
Dan: Let’s take that tumbler half full and add slightly bit to it. Because along with their story, Bob gave us yet another factor: His spreadsheet. And we’ve been including to it.
Claire: Yep. We’ve obtained a template you’ll be able to obtain — it’s within the present notes for this episode, and it’s in our First Aid Kit publication. And along with GoodRx, and a few comparable websites, and CostPlus, we’re including traces the place you’ll be able to log costs from a world Bob didn’t discover.
Dan: I imply, he’s only one man.
Claire: So, one factor we’re including: ordering from pharmacies outdoors the U.S.
Drug costs are decrease principally in every single place else, and a few pharmacies in Canada will ship to the U.S. To keep away from shady web stuff, a device referred to as Pharmacy Checker will steer you to ones which are above board.
Dan: Another addition: Manufacturer coupons. SOMETIMES, particularly with brand-name medicine, pharma firms provide coupons that may make medicine inexpensive.
Claire: There are plenty of caveats with these too.
Dan: Oh man, inform me about it. But not proper now. There are TOO MANY doable workarounds, too many caveats, for anyone particular person to bear in mind. That’s why we’re doing this throughout two episodes and FOUR installments of our First Aid Kit publication.
It’s all exhausting, and there’s no ensures. But it’s all value understanding. And with assist from Bob, and plenty of listeners who chimed in, we’re boiling issues down and placing them in varieties we hope you’ll discover helpful.
As all the time, DEFINITELY please tell us how the stuff we offer may be even higher.
You can discover the First Aid Kit publication at arm and a leg present dot com, slash first support package. New installments there each week. We’ll have a hyperlink wherever you’re listening to this.
And in our subsequent episode, we’ll dive into some ideas that actually stunned us, from people who do this sort of factor for a residing.
Erika: I suppose in my coronary heart of hearts, I would like everybody to be taken care of. Dan: For now, Claire: Thank you a lot for bringing us Bob’s story. Claire: My pleasure!
Dan: And we’ll be again with the second episode on this sequence in just a few weeks. Till then, handle your self.
This episode of An Arm and a Leg was produced by Claire Davenport with assist from me, Dan Weissmann, and Emily Pisacreta. And our new intern: Welcome Lauren Gould! It was edited by Ellen Weiss.
Adam Raymonda is our audio wizard.
Our music is by Dave Weiner and Blue Dot Sessions.
Bea Bosco is our consulting director of operations.
Lynne Johnson is our operations supervisor.
An Arm and a Leg is produced in partnership with KFF Health News. That’s a nationwide newsroom producing in-depth journalism about well being points in America — and a core program at KFF: an impartial supply of well being coverage analysis, polling, and journalism.
Zach Dyer is senior audio producer at KFF Health News. He’s editorial liaison to this present.
An Arm and a Leg is Distributed by KUOW — Seattle’s NPR station. And because of the Institute for Nonprofit News for serving as our fiscal sponsor.
They enable us to just accept tax-exempt donations. You can be taught extra about INN at INN.org.
Finally, thanks to everyone who helps this present financially. You can take part any time at arm and a leg present, dot com, slash: help.
Thanks! And thanks for listening.
“An Arm and a Leg” is a co-production of KFF Health News and Public Road Productions.
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