Dan Weissmann
In response to the excessive value of prescribed drugs, “An Arm and a Leg” requested listeners to share their methods for getting the drugs they want at costs they’ll handle.
Host Dan Weissmann and producers Emily Pisacreta and Claire Davenport share suggestions from a retired hospital supervisor who now helps seniors discover the precise Medicare plans, a pharmaceutical gross sales rep, an worker advantages adviser, and a battle-worn hospital caseworker. Each brings stunning, perhaps even lifesaving, data to the desk.
Explore the total crowdsourced collection, together with 5 installments of the “First Aid Kit” e-newsletter: The Prescription Drug Playbook.
Dan Weissmann
Host and producer of “An Arm and a Leg.” Previously, Dan was a employees 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
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Transcript: The Prescription Drug Playbook, Part II
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 software however verify the corresponding audio earlier than quoting the podcast.
Dan: Hey there. Let’s meet Jeanne Chamberlin from North Carolina. She frequently talks with of us who take like 15 totally different meds each day.
Jeanne Chamberlin: You are like, oh my gosh. And actually the retail prices are $20,000 a month.
Dan: Jeanne’s an skilled, twice over. Since retiring from a profession managing hospitals and medical teams, she’s been serving to her fellow seniors determine methods to handle what they pay for well being care — as a county-level volunteer coordinator for a program referred to as SHIP.
Jeanne: And SHIP stands for Seniors Health Insurance Information Program.
Dan: Actually in some circumstances it stands for State Health Insurance Assistance Program.
Whatever you wanna name it — It’s a federally funded program that helps seniors with all issues Medicare. Every state has its personal model of SHIP.
During the busy season — that’s within the fall, when individuals can choose new insurance coverage for the approaching yr– Jeanne says she and her crew converse to greater than 100 individuals per week.
And one factor that comes up in mainly ALL of these conversations: Can I modify issues to get my meds for much less subsequent yr?
She says one yr, her crew added up the affect of these conversations. Half of the individuals modified plans, and on common, they saved 300 {dollars}. Not unhealthy…
Jeanne: But there have been many, many individuals who saved a thousand, 2000, even $10,000 by altering from one Medicare plan to a different primarily based completely on the price of their medicine.
Dan: Jeanne’s gonna inform us how she helps individuals get these sorts of financial savings– with methods that aren’t only for individuals on Medicare.
And Jeanne is only one one who wrote to us once we requested for you, our listeners, to inform us about your techniques and methods for coping with the excessive price of prescribed drugs.
The consequence: two podcast episodes– that is quantity two — and 4 installments of our First Aid Kit e-newsletter.
In this episode, we’re gonna hear from Jeanne and three different *unimaginable* sources who got here to us with essential insider data. Knowledge that — now they we have now it– we have now to share with you.
Jeanne’s gonna assist us get arrange. She’s gonna share what she tells these seniors, and the way it can apply to anybody, at any age.
… Then, a pharma insider is gonna air an open secret.
An worker advantages advisor — a sort of scout for offers — will inform us the place she’d ship somebody struggling to pay for meds.
Finally, we’ll meet a battle-worn hospital caseworker. And past the particular tip she wrote in with, her work – and life story – are gonna deliver us some deeper perspective.
These individuals kick ass.
And for all their recommendation, there’s, in fact, a BIG caveat:
like we stated final episode — your mileage will fluctuate. There is nobody resolution for everybody. This is a set of patches, workarounds, bandaids.
To be sincere, lots of them are literally bizarre byproducts of the profit-making machine. Which is an enormous cause they’re so patchy and unreliable.
We deserve SO a lot better. But within the meantime, we might help one another. That’s what this venture is about. Including the 4 e-newsletter installments I discussed. And we’ll hyperlink to these from wherever you’re listening — so: you don’t want a pencil and paper right here. We’ve obtained you.
Our hope is that you simply stroll away from all of this armed with a *little* extra data that might allow you to or somebody you care about get the meds they want. A sort of leg up. An Arm and a Leg-leg-up.
This is An Arm and a Leg, a present about why well being care prices so freaking a lot, and what we will perhaps 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 many
most enraging, terrifying, miserable components of American life, and convey you one thing entertaining, empowering, and helpful.
So, first: Jeanne wrote to us about what she is aware of from serving to individuals enroll in Medicare. But she additionally had an instructive private story to share. Because even specialists must scramble generally.
Some time in the past, when Jeanne’s husband had a intestine an infection, he obtained prescribed two antibiotics. His insurance coverage protection meant one was gonna price him thirty bucks. But the opposite one? His plan didn’t cowl it And… .
Jeanne: It was $1,200. For a 14 day provide it was simply obscenely costly.
Dan: So instantly, Jeanne says she went into drawback fixing mode. And her order of operations gives a terrific template for any of us.
Step one: Google for reductions. Just taking a fast first move on the sort of factor we talked about in our final episode. Maybe that’s GoodRx. Maybe that’s a coupon from the drug maker. Results for Jeanne: Not nice.
Jeanne: I may get it all the way down to $800. It’s like, nonetheless, you’re like $800. Really?
Dan: So, on to step two: Tell your supplier there’s an issue and ask for recommendation.
Jeanne: We went again to the physician and stated, is there one thing else that you realize you are able to do?
Dan: Jeanne was considering: Maybe the doc may suggest one other antibiotic — one which insurance coverage would cowl. Or assist them combat her husband’s insurance coverage to get this drug coated.
But really, the doc’s proposal was a lot less complicated.
Jeanne: She stated simply take the opposite one.
Dan: Just take the one Jeanne’s husband may get for thirty bucks. Skip the second drug.
Jeanne: So he did, and he was advantageous!
Dan: END OF STORY. In this case. It’s not at all times that straightforward. But the ethical is: ASK. If your insurance coverage covers a special drug, your doc can inform you if it’s a great wager for you. If not… nicely… we’ll come again to different methods your doc may assist.
But proper now let’s transfer on to the most important, most useful recommendation Jeanne provides to seniors– and that applies to all people.
Especially anyone with meds they’re taking long run, like blood strain or ldl cholesterol meds, or no matter.
And the recommendation is that this: Look forward, yearly.
In the autumn, when it’s time to join subsequent yr’s insurance coverage plan: Get a take a look at the checklist of which medicine your insurance coverage will cowl, and the way a lot they count on you to pay for them. It’s referred to as the formulary.
Because even for those who don’t change something about your insurance coverage, your insurance coverage may change the formulary. That can occur to anyone.
Jeanne sees it on a regular basis with seniors, when their plans reboot at New Year’s.
Jeanne: People are available in January and this occurs yearly, and say, I simply went to the pharmacy and. They need $300 for my drugs. And final yr, or final month in December, it was $30.
Dan: These of us didn’t plan to alter something about their insurance coverage — however their insurance coverage plan modified on them– and stopped overlaying a drug they’ve been taking. Now they’re getting charged sticker value.
And Jeanne’s like, ‘Man, I wish you’d have come to see us in the course of the fall sign-up– open enrollment.’
Jeanne: We may have in all probability discovered a plan that coated that drug nonetheless..
Dan: Now, it’s true that folk on Medicare are likely to have extra decisions than the remainder of us right here. In Medicare, drug protection is its personal separate plan — referred to as Part D — and seniors in Jeanne’s county have greater than a dozen to select from.
If you get insurance coverage from work — and perhaps there’s only one plan — this factor of trying forward is perhaps much more vital.
At some level, perhaps a pair months earlier than the brand new yr, it’s best to get an opportunity to see that subsequent yr’s formulary
And it may say, “Hey, your drug is gonna be more expensive for you next year”
That’s your cue to start out problem-solving immediately. Get a plan in place earlier than that new value kicks in.
Step one: Check: Can you discover reductions on-line that make this drug inexpensive? Cool.
No? Time to get in contact together with your supplier’s workplace: begin tapping their experience.
Jeanne: The supplier usually has lots of people together with your situation and doubtless prescribes this medicine quite a bit.
Dan: And so, in case your insurance coverage firm says they’ve obtained another drug you possibly can take, one they’ll pay for– your supplier will know: may that drug be just right for you?
And for those who’ve obtained a selection of plans — however all of them require a particular approval course of now on your drug — your supplier will know: Is one in every of them extra more likely to really subject that approval?
Jeanne: Ask them a few plan the place they’ve a simple time getting it authorised for any person together with your situation the place it at all times goes by way of.
Dan: And that’s the plan you need to choose. And, talking of getting your insurance coverage firm’s approval:
We’re about to maneuver from Jeanne’s recommendation– plan forward, get your supplier to assist — to the following step. Because you possibly can’t plan every little thing. Sometimes you get sick, with one thing new. No planning for that.
And generally, your insurance coverage is unquestionably not gonna say sure immediately to the drug your doc thinks you want. And your doc thinks you want this specific drug. So, how ELSE can your supplier assist?
John: I work, uh — work for an trade with an approval ranking beneath Congress.
Dan: He’s a pharmaceutical gross sales rep! He requested us to maintain his full identify and employer confidential.
He’s additionally an Arm and a Leg fan.
John: I find it irresistible when, uh, I hear tales of common individuals simply sticking it to the insurance coverage firm. It’s good when the affected person wins, trigger they don’t get lots of wins.
Dan: We reached John in his main workplace — often known as his automotive.
When we requested listeners a number of months in the past to share classes about getting prescription meds with out paying an arm and a leg, he wrote proper in with suggestions.
And one, I like only for the perspective. Here’s John studying from the e-mail he despatched us:
John: Step therapies. Uh, denials and value at pharmacy ought to be seen as strategies.
Dan: Suggestions. Perfect. The different is rather more particular. As a salesman, an enormous a part of John’s job is prepping medical doctors for the fights they’re gonna have with insurance coverage corporations, to get approvals for medicine. He does that as a result of approvals for them imply gross sales for John.
Of course, approvals take time.
John: But one factor that you realize doesn’t care about time is ailments.
The illness of Crohn’s or Bipolar dysfunction, no matter, isn’t like, look, I’ll maintain off on affecting you till this prior authorization is finished.
Dan: So right here’s John’s recommendation: whilst you’re preventing for that approval– pushing again on the insurance coverage firm’s “suggestion” that you simply strive one thing else– Ask your supplier if they’ll get free samples from the pharma firm — from a rep like him.
John: And the supplier hopefully will say, yeah, let me name the rep and we’ll depart some at entrance for you.
Dan: Actually, your supplier might have already got some readily available. A research from a number of years in the past discovered that TWO THIRDS of primary-care practices had CLOSETS of pharmaceutical samples. Which, wow.
So, let’s handle one thing huge: Like John joked about as we launched him, pharma gross sales reps are NOT usually appeared upon as mannequin residents.
The rap is: Some of them use less-than-scrupulous techniques to encourage medical doctors to prescribe costly medicine… even to sufferers who may not get additional profit from a selected drug. Or, within the case of opioids — which obtained pushed actually onerous — would possibly trigger hurt. And free samples are a part of that course of.
So, some suppliers received’t meet with gross sales reps in any respect. Some well being methods don’t enable any of their employees to satisfy with them.
But you don’t must approve of how pharmaceutical corporations do their enterprise to make the most of John’s suggestion. And neither does your physician.
John says, to get free samples, your physician may not even want to speak to anybody.
They can simply make a request on-line, on the producer’s web site. John says it positively occurs.
John: So even with suppliers or medical doctors that I’ve by no means seen in my 9 years, I do know that they’ve gotten samples earlier than.
Dan: But right here too, there shall be limits.
John: Some producers don’t even do samples. So it actually varies quite a bit. Dan: But lots of these samples do exist —
And the thought of utilizing them as a stopgap whilst you combat to get your insurance coverage to pay for the meds you want — I had by no means considered it till we requested you, our listeners, on your suggestions.
And you additionally despatched us this: Could an area clinic provide the meds you want for a value you possibly can really afford? That’s subsequent..
This episode of An Arm and a Leg is produced in partnership with KFF Health News. That’s a nonprofit newsroom overlaying well being points in America. Their journalists do wonderful work. We’re honored to be their colleagues.
OK, a complete new sort of skilled right here. Like Jeanne, who we heard from earlier. Cristy Gupton additionally lives in North Carolina. She works as an impartial worker advantages designer. You’re in all probability like, what the hell is that? Here’s how she describes her work.
Cristy Gupton: Imagine you’re a child in highschool, in store class, and your trainer places an outdated engine on the desk, and says, take it aside and put it again collectively once more and ensure it really works.
Dan: Except, the machine is a well being profit program for employees. And– again to the shop-class metaphor — Cristy says she’s the actual gear-head within the room .
Cristy Gupton: By the time I put the engine again collectively, it really works twice pretty much as good, however at half the fee.
Dan: Cristy says she does it by ditching costly, off-the-shelf components — normal insurance coverage insurance policies from huge corporations — for customized options. It’s a WHOLE THING, and super-interesting, and price going into.
For now, she’s obtained one huge tip that *some* of us may use to get entry to meds at super-low costs. Basically it’s this: Look for a neighborhood well being middle that gives a sliding scale. They can get medicine at extraordinarily low costs, by way of a federal program referred to as 340B.
How low?
Cristy Gupton: The drug Humira is among the most prescription drugs in America. And the checklist value might be someplace within the neighborhood of 5,000 a month. But a 340B coated entity may buy it for a penny.
Dan: So we checked, and really: Humira’s checklist value isn’t 5,000 {dollars}. It’s 7,000 {dollars}. But YES, a 340B clinic can get it for a penny. Now, they don’t get each drug that low cost, however..
And look: though that is all very a lot value figuring out about, it’s not assured to be just right for you.
340B is difficult in every kind of how. Here’s my colleague Emily Pisacreta asking Christy about it.
Emily: Help me perceive what 340B is.
Cristy Gupton: I’ll provide you with my finest, um, like solely know sufficient to be harmful reply.
Dan: After checking some precise specialists, right here’s what we expect you should know:
A federal legislation from the Nineties — part 340B of that legislation — mainly requires drug-makers to provide some hospitals and well being facilities that serve low-income of us super-duper reductions on meds.
Those reductions don’t at all times get handed alongside to sufferers. The feds say hospitals and clinics can take a revenue, to subsidize their different work .
But the foundations say: neighborhood well being facilities DO have to make medicine inexpensive to individuals with decrease incomes. Specifically, to individuals who make lower than two occasions the federal poverty stage.
For 2025, that’s simply over 64 thousand {dollars} for a household of 4. Not quite a bit.
But it’s lots of people: More than 28 p.c of Americans qualify. And some clinics might have sliding scales for individuals with increased incomes than that.
So: There’s a search software. We’ve obtained a hyperlink wherever you’re listening to this. Find a clinic in your space, name them, and see what the deal is.
One final thing to know: You’ve gotta really be a affected person on the clinic as a way to use this program. And really, for those who meet the revenue necessities, all of the clinic’s companies are gonna be super-subidized.
But for those who don’t need to interact too deeply with the clinic– don’t need to swap over all of your care to a brand new crew — Cristy says, in her expertise, you could not must.
Cristy Gupton: It will be as free as they only have a digital go to. I imply, that’s fairly easy.
Dan: Again, we’ve obtained a hyperlink to the search software for locating a well being middle close to you. Which in fact…close to you… not all people is gonna have. Your mileage might fluctuate, actually. But is it value checking? Yeah, I feel so.
OK we’ve thrown a LOT at you. I do know, I do know. And we do have yet another set of skilled suggestions. From somebody we’re actually glad to have met. So right here’s Erika — and her experience is a part of a lifelong venture.
Erika: You know, as a baby with Type one diabetes, I had a really dysfunctional family and I needed to deal with myself from a really younger age. I’ve discovered that the abilities that I developed as a baby with a continual sickness are transferable right into a profession to assist individuals be taken care of.
Dan: So now, she works as a affected person navigator– a sort of case employee, at a hospital in rural Oregon.
When my colleague Emily talked with Erika, they bonded slightly.
Emily: I dwell with Type One Diabetes and I actually want that I had had a affected person navigator, um, after I was identified.
Erika: Yeah, I want I had me as a affected person navigator too.
Dan: Most of the sufferers Erika does work with are managing continual situations and different severe well being issues, below robust circumstances.
Erika: For instance, let’s say a affected person has an amputation they usually’re instructed on discharge to maintain it elevated and preserve it clear. Well in the event that they’re dwelling of their automotive, that may be a problem. So in that case, case administration would attempt to discover them a resort for a pair weeks.
Dan: And in fact, probably the most widespread issues she tackles: serving to individuals get their meds at costs they’ll afford.
Erika: There are weeks the place that’s all I’ll do.
Dan: For insured sufferers, Erika he begins with drugs-and-insurance 101: Helping them determine which medicine their insurance coverage covers, at what value to them, and training them earlier than they name their insurance coverage firm.
Erika:I supply to be on the decision with them if they need. And I’ll inform you proper now that we’re gonna be on maintain with that insurance coverage firm for half-hour
Dan: Yeah, that sounds acquainted. Also, for some sufferers on Medicaid, Erika runs interference with bureaucracies.
And, when there’s no method that insurance coverage will make the precise medicine inexpensive for her sufferers– together with of us with no insurance coverage in any respect– Erika helps them discover one of many choices she wrote in to us about.
“Patient Assistance Programs” primarily based on revenue. Some are from producers, others come from personal foundations.
Erika: It’s such a matter of any person figuring out who to ask and the place to get the stuff.
Dan: And there are web sites to search out this sort of factor — we’ve obtained hyperlinks and guides for you — and she or he says the purposes aren’t difficult.
But the individuals she works with, they want additional assist.
Erika: A variety of my sufferers don’t even know methods to use a pc or to get onto the web, or they don’t have sensible telephones, they only have cell telephones. So lots of them, I meet with them. I take my laptop computer, and we do an internet software. I assist them fill it out.
Dan: And then hope it really works. Some applications solely give out a lot help per yr, so not all people will get assist.
Erika: It’s a irritating combat. I really feel unhealthy that individuals must wage this, you realize, to get what they should be wholesome. It’s, it’s not like persons are asking for BMW or new clothes. People are asking for, oftentimes medicines they should preserve themselves alive. It’s, it’s like asking for oxygen. Like what for those who have been instructed you you couldn’t afford oxygen? That’s the best way individuals really feel generally.
Dan: And that’s why, though Erika wrote to us about sensible specifics, it’s her method, her presence that we particularly wished to share with you.
Erika: I suggested all my sufferers to get a tattoo that claims, be persistent. I imply, significantly, I don’t count on them to get tattoos. But as a affected person who manages a continual situation, you simply must be.
Dan: Oh yeah. The ongoing burden of coping with all this, it’s a bear. And it got here up repeatedly whenever you wrote in to us.
Erika: Yeah. Stress administration, whew.
Dan: For Erika’s sufferers, and for herself too.
Erika: I’ve to recollect to love, cease, step away, do some respiration. And these are issues I train to my sufferers slightly bit too. Like, okay, let’s cease and do some respiration collectively on the telephone. Okay.
Dan: She calls her technique “self compassion.” It’s about serving to individuals see how a lot they’re already doing.
Erika: I encourage individuals to take a second and respect that about your self. Okay? you’ve been on the telephone together with your insurance coverage firm for half-hour.
You’re attempting to get this executed. You really want to understand that you simply’re doing that on your well being. For your well being. Feel good about that, no less than.
Dan: You are taking time to take heed to this podcast. We are right here, proper now, collectively, doing our greatest.
For the sensible classes — all of the issues to strive, that will or might not work — we’ve executed our greatest to write down them down for you, and set up them so that they’re helpful, in our First Aid Kit e-newsletter. Four installments.
You can discover these newsletters — and these episodes — at Arm and a Leg present, dot com, slash, medicine.
That’s the handle the place we first requested you to share what you’d discovered by strolling by way of this maze. Now we’re inviting you to come back and see what we’ve discovered from you.
Arm and a Leg present dot com, slash medicine. There’ll be a hyperlink wherever you’re listening to this.
And you’ll discover yet another factor there, too.
To honor the limitless and ridiculous course of that we generally must undergo to get our medicines… my colleague Claire Davenport, who has led the reporting for a lot of this collection, made an limitless and ridiculous track. Well, with the assistance of an AI. Stay tuned after the credit for slightly style of that.
We’ll be again with a brand new episode in a number of weeks.
Till subsequent time, deal with your self.
This episode of An Arm and a Leg was produced by Emily Pisacreta and Claire Davenport with assist from me, Dan Weissmann, and Lauren Gould.
And 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 the 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 all people who helps this present financially. You can take part any time at Arm and a Leg present, dot com, slash: help.
And NOW….slightly deal with.
So: At one level, we have been like, “What if we could make like a jingle to help people remember all the tactics we’re talking about?”
But when our producer Claire tried really writing one, with AI supplying the melody and the band — it simply kinda confirmed us how limitless and ridiculous the checklist really is.
And we discovered that simply lovely. Here’s the way it begins…
AI Song: I’m a prescription – medicine. And as you would possibly know, I’m Expensive on this nation. Getting me will be complicated. And typically fairly scary. Since with regards to meds. The costs can fluctuate. Luckily, there’s some methods you possibly can strive. When you’re on this scenario and the value is excessive…
Dan: Alright, I feel you get the thought — and if you’d like extra, it’s all at Arm and a Leg present dot com, slash, medicine. Along with these podcast episodes and First Aid Kit e-newsletter installments, and every little thing we hope you’ll really discover helpful. Thanks.
“An Arm and a Leg” is a co-production of KFF Health News and Public Road Productions.
For extra from the crew at “An Arm and a Leg,” subscribe to its weekly e-newsletter, First Aid Kit. You can even comply with the present on Facebook and the social platform X. And for those who’ve obtained tales to inform in regards to the well being care system, the producers would like to hear from you.
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