Brian understands how much the right help matters when things seem bleak.
He has liver disease and developed an infection caused by a buildup of toxins in his blood. The infection is very serious and can be life-threatening without proper treatment. On top of this, he’s been feeling confused, which is often a side effect of an infection like this. It’s been difficult for him to concentrate on everything he needs to handle day-to-day.
Brian’s symptoms alone are enough to cause him major stress. But in addition, his monthly prescription costs have been slowly building and are starting to feel overwhelming. With his health plan, he pays 100 percent of the cost of his medications. And the one he needs to treat his infection costs over $2,600 a month—much more than he can afford.
Luckily, as Brian’s health plan is through Meritain Health®, it also includes access to the CARE Program, part of Meritain Health Pharmacy Solutions (MPS). A CARE specialist became aware of Brian’s dire health situation and his mounting health care costs. She stepped in and began researching ways to help right away.
Her first thought was to try a patient assistance program—but sadly, he didn’t qualify for this. However, she did find $28,000 available in copay assistance through the medication manufacturer. This was great news! Once approved, these extra funds would go a long way toward helping Brian chip away at his medication costs for the year.
Still, Brian’s CARE specialist was confident she could do more. Through some digging and the use of test claims, she reviewed coverage from a few pharmacies. Her results showed a CVS pharmacy location had the lowest prices. In fact, through CVS pharmacy, Brian could cut his medication costs almost in half! So, by switching here, Brian would be able to stretch the copay assistance he was receiving much further. By having his provider send his prescriptions to a CVS pharmacy near his house, Brian’s out-of-pocket costs would be $0 for ten refills, close to a whole year.
This news all felt too good to be true! Brian had nearly given up on finding any help with his costs. But, thanks to the hard work of his CARE specialist, he could get the life-saving medication he needed along with a healthy dose of relief.
Brian’s CARE team will be checking on him regularly as he begins treatment and starts on the path to recovery. And they’ll be reaching out to make sure he can secure additional funds to help with costs in the coming months. Brian is very grateful for his Meritain Health benefits and for his CARE team, who helped protect his health, peace of mind—and truly saved his life.
This story is based on an actual member experience. Names and information have been changed to protect the member’s privacy.
This communication is intended for informational, promotional purposes only. The reference to previous outcomes made as a part of this communication does not guarantee success or similar outcomes in any new or future cases, as the result of each case depends upon many factors, including but not limited to the facts of each case. Any actual savings will vary based upon numerous factors, and neither Meritain Health nor its affiliates guarantees any level of savings.
