Transcription:
Medication Assistance: Resources to Access Affordable Medications

Intro:  This is BayCare HealthChat, another podcast from BayCare Health System.

Tony Martinez: If you've experienced a medical emergency, you know that restoring your health sometimes comes with a cost for the medications used to treat your condition. Thankfully, there are resources available to ease your mind and help you access affordable medications. This is BayCare HealthChat. I'm Tony Martinez.

Marissa Rogoff is a clinical pharmacist at BayCare Health System, and she joins us now to discuss the medication assistance program at BayCare. Marissa, thank you so much for being with us. What is BayCare's Medication Assistance Program?

Marissa Rogoff: Our program, we're a team dedicated to really ensuring patients have access to affordable medications. So we're a team of assistance coordinators with myself as being the pharmacist on the team. We help connect patients with different assistance resources with our goal to make their medications ultimately more affordable.

Essentially, we help review these available resources with them and we help patients apply for any programs they might be eligible for. So some of these resources, they could be coupons, assistance programs from the different medication or drug companies and even certain pharmacies actually have lower prices for certain medications as well. And in some circumstances, we can even recommend lower cost alternative medications for patients too.

Tony Martinez: Fantastic. Who would you say this program is mostly intended for?

Marissa Rogoff: So we help a wide variety of patients. Most of our patients are BayCare patients or our team members, but really anybody within the community where BayCare services patients throughout Tampa Bay and even the west central region of Florida. But, you don't have to be a BayCare patient to use our services. We help a lot of patients who see other doctors. You just have to be in our overall area. And it's really for anybody. Any type of insurance, we help patients with no insurance, with Medicare, Medicaid. Certain circumstances where we might not actually be able to ultimately help someone, but anybody who meets that criteria, we can assess to see if they qualify for any resources.

Tony Martinez: I think that's so fantastic that you offer this program for those who are not even, you know, patients of BayCare. That's just so fantastic. So if someone is listening and interested, and who wouldn't be, how do they apply for this program?

Marissa Rogoff: They don't necessarily need to "apply" to us per se. All they would need to do is give us a call at our team's phone number, which is (813) 901-6350. Or they can send us an email at our team's email, which is This email address is being protected from spambots. You need JavaScript enabled to view it. just to reach out to us if they need help. And at that point, we start assessing to see if they qualify for anything. That being said, there are certain programs that still might require an application process. So they don't need an application to use us necessarily, but there are resources out there that do require an application.

Tony Martinez: Do you have a deductible?

Marissa Rogoff: So that's a great question to ask patients. So for people who don't know what a deductible is, it's essentially your insurance makes you spend a certain amount of money first before they start to kick in and to help cover costs. So it's really important to know if you have one and how high it is.

I mean, time and time again, we have patients who think, you know, their medications are going to be that high every single month when in reality it's really only once or twice that they have to pay that much before their cost drops down, which happens once they meet that deductible. So it's really important to know that that's something that your plan has or not.

Tony Martinez: And a great question for you to ask your physician for sure. Another important issue is that under a health care plan, the list of covered prescription drugs is called a formulary. The formulary is usually divided into tiers or levels of coverage based on the type of usage of that medication. Each tier will have a defined out-of-pocket cost that the patient pays before receiving that drug. So what tier is your medication? And why is that good information for our patients to know?

Marissa Rogoff: So, as you said, a tier there's different levels of coverage, anywhere from tier one up to tier five. Some plans go higher than that, but most plans you're looking at a tier one through tier five. Tier one and two are your lower costs, more inexpensive, generic medications. Typically, a tier three is a preferred brand name drug, meaning your insurance prefers it, so it's less expensive, but still can be expensive. Tier four, they're still covered, but they may be non-preferred by your insurance, so it's more expensive. And typically, your tier five are your very expensive specialty medications.

And so, the higher the tier, the more potentially expensive the medications get, and the reason why that can be important to know is that maybe you're recently prescribed a medication and it's tier three, but maybe there's a medication that's just as good as this tier three medication that happens to be tier two and would be a lower price. So having a good idea what tier it is can be helpful sometimes with cost savings as well.

Tony Martinez: And again, that information is really important while you're there with the physician, isn't it?

Marissa Rogoff: It definitely can be. You know, someday I'd like for someone to invent, you know, when a doctor prescribes a medication that they'll automatically know the price, but it doesn't work that way, unfortunately. So having a better idea of coverage can definitely be helpful.

Tony Martinez: Absolutely. And does your insurance have a preferred pharmacy?

Marissa Rogoff: Not all insurance plans have preferred pharmacies, but a lot of them do. And if they do, if you fill through that preferred pharmacy, it's going to be a lot less or potentially less expensive than going to a pharmacy that's not preferred. So that's definitely another opportunity for cost savings. Making sure if your insurance does have a preferred pharmacy, that's where you're filling your prescriptions.

Tony Martinez: Interesting. Dr. Rogoff, as you know, there's a growing trend towards mail-order pharmacy services. In mail-order, your physician sends the prescription to a mail-order pharmacy, which generally works through the insurance company and its pharmacy benefits manager. Your prescription is filled by the mail-order pharmacy, run through the insurance, and then the medication is just mailed directly to you. Are you required in this plan to go through mail-order or not?

Marissa Rogoff: It depends on the insurance plan. Some of them don't require that, but a lot of especially commercial or private plans might definitely require going through mail-order. And that's important to know because if it requires you to go through mail-order, but you've been going to a retail pharmacy, your insurance might actually charge you more. So it's definitely something to double check, whether that's a requirement or not. And not only that is sometimes even if it's not a requirement, sometimes going through mail-order pharmacy could overall provide some cost savings too. So that's something to double-check as well.

Tony Martinez: Great information there. Talk a little bit about 30 and 90-day fill. For the patient, why is that important to know regarding the insurance?

Marissa Rogoff: Typically, when a doctor writes a prescription, it's very common they'll either write it as a one-month supply or a three-month or 90-day supply. There's personal preference to both. Some people like 90-day supplies, because they don't have to go to the pharmacy as frequently. There's reasons to do either way, but the biggest reason sometimes is your insurance can dictate what they'll fill. Whether that's a 30 or as a 90-day supply, they require maybe one or the other. And if it's not being filled as the one that the insurance is requiring, it could again cost you more money, which we don't want. So knowing if your insurance requires that or, you know, what direction, or maybe it doesn't matter, it depends on your insurance plan, can be important to know.

Tony Martinez: I was wondering if you have an emergency and you need that medication immediately, does the medication require prior authorization? Sometimes, time is of the essence in some of these situations for patients.

Marissa Rogoff: So prior authorizations, they're a part of health care and it depends on the insurance in terms of how quickly that they can be done. So essentially, for those that don't know, prior authorizations essentially means your insurance is not covering that medication right off the bat. They're requiring that your doctor's office either submit paperwork, make a phone call, go through some extra steps to basically say, "Yes, this is medically necessary for this patient, you know, showing why the patient needs the medication before the insurance will cover it.

So depending on the insurance and the situation, every insurance plan is different. Some might take longer to process that, others it'd be very important to ask to, one, start that process immediately, but, two, to make sure about the insurance company knows it's urgent and to see if they have a way to expedite that process.

Tony Martinez: Okay, that's vital. Another concern some patients have is the effectiveness of generic medications. Generic medications are often as we know significantly less expensive than the brand name counterpart, but how would you rate the efficacy in general of these generic medications?

Marissa Rogoff: So in general, I would say generic medications are just as effective as their brand name counterparts. For majority, now, as you can see, I'm not saying all, there are some exceptions out there. There are certain medications where some patients might respond better to a generic or a brand, or it does make a difference that they're switching from one to the other and that's something for you to talk to your doctor about. But for the most part, most medications using the generic is just as effective. And I recommend that because you're saving money with going to that generic route.

Tony Martinez: So do patients have a choice if for some reason they prefer one over the other?

Marissa Rogoff: So technically yes, if a patient really wants that brand name, they have a choice. But they just have to keep in mind oftentimes their insurance might not cover that brand name medication, so then they're going to end up paying a lot more for that medication. And sometimes there have been medications that have been generic for so long, the brand names might no longer be available. So that's something to double-check as well.

Tony Martinez: Well, this is just some great information, I believe. And there are just so many questions about medical assistance for these different medications that I believe this is really so helpful for our patients. Are there other resources available from the drug manufacturers, for instance, in terms of helping patients reduce the cost of these drugs?

Marissa Rogoff: A lot of the drug companies do provide different assistance resources. One of the main ones that we help patients with, a general name for what we call patient assistance programs. And what that is it's an application process through the drug company, where if you meet certain criteria and you go through the application process and get approved, you can get that medication for free. Not everybody qualifies or is a good candidate, but for those who are that is an option. Also, a lot of the major manufacturers make what I like to call copay cards or savings cards are basically coupons and those can provide assistance. Usually, it's only for commercially insured patients. Sometimes uninsured, but the main focus for those are commercially or privately insured patients and it doesn't make it necessarily free, but it can significantly reduce the cost.

Tony Martinez: Interesting. So what are the boundaries of this program in Florida for those listening, and we can get listeners from all over the world. Where would you say that they need to be living in specifically to be able to use these services?

Marissa Rogoff: So most of our patients are going to be throughout the Tampa Bay Area as well as West Central Florida regions. So really, where any of our major BayCare Hospitals or where BayCare's being marketed. But again, you don't have to be a BayCare patient. That's just to use our services, which is to help patients navigate available resources.

That being said, most of the resources we help connect patients with are definitely available nationwide. So if you have a concern or someone has a concern about the cost of their medication or a family member's medication, I definitely encourage you to talk to your doctor, because let's say you could live out in California, in New York, Ohio, you can still connect to those same resources that we help our patients with down here in Florida.

Tony Martinez: And I really think it's important to emphasize the fact that you are a connection for these patients to find those resources to help pay for these medications' costs. These are not the costs that are involved with your provider, for instance, correct?

Marissa Rogoff: That is absolutely correct. The help that we're providing patients with is specifically only for medications. So we do not assist with medical costs such as, like you said, seeing your provider or a hospital visit. I know here at BayCare, we have a separate department that helps with those. It's our financial assistance department. And I know many other health systems have a similar set up to help patients with those other costs.

Tony Martinez: Well, it sure seems like BayCare is doing everything it can to help patients get these medications at an affordable cost. And that leads me to my last question, why is this program so vital to you and the BayCare Health System?

Marissa Rogoff: There's nothing more important than our patient's health and wellbeing. And in today's world, medications can play a major and important role in keeping our patients healthy. However, unfortunately, many medications can be expensive and the cost can be a barrier to someone taking their medication. And navigating these assistance resources, it's not an easy process. And that's where we come in to provide guidance.

Someone shouldn't have to choose between keeping their food on the table or paying for their medications. Someone shouldn't have to ration their medications because they can't afford to take it as prescribed. We want to make sure that paying for medications is one less thing people need to stress or worry about. And we want to make sure that people are heard, their concerns are addressed and that they're ultimately happy with their care and, above all, to be healthy and be able to have affordable access to their medications.

Tony Martinez: Fantastic. Dr. Rogoff. Thank you for this information on the medical assistance program. It is very much appreciated. Now, please go to our website at BayCare.org for more information. In addition, please remember to subscribe, rate and review this podcast and all the other BayCare podcasts. For more health tips and updates, follow us on your social media channels. For BayCare HealthChat, I'm your host, Tony Martinez.