Success Story: Compassion and Experience Add to Savings

Success Story: Compassion and Experience Add to Savings
May 3, 2021 Laura Dziomba
Success story major prescription savings

Sofia has a condition she doesn’t talk too much about.

She suffers from a rare bleeding disorder, and it’s something that causes her a lot of anxiety. For as long as she can remember, she’s been dealing with things like frequent nosebleeds, and she has to be extra cautious to avoid getting cuts and scrapes. This can be difficult, as she loves gardening in her spare time. She’s very prone to bruising on her arms and legs, too, so she gets a little nervous when doing everyday things like walking the family dog. He likes to go fast and pull on his leash, so she has to be careful not to trip or bump into anything.

Over the years, Sofia has tried countless medications to control her symptoms. Most didn’t really help. But after plenty of trial and error, she finally found one that works for her.

One day while out working in her garden, Sofia remembers she’s getting low on her pills. She heads back into the house and calls her doctor’s office to see about having her prescription refilled.

During her phone call, she learns there’s been a change to her employer coverage. The medication she’s come to count on is no longer covered under the plan. As a further blow, Sofia also learns her medication is considered a high-cost prescription, and to refill it on her own would cost her $900,000 for a year.

After hanging up the phone, Sofia sits in complete shock for a moment. She knows this medication is critical to maintain the quality of life she’s found, but has no idea how she would ever afford something in that price range. And she only has enough medication left for about a week.

Luckily, through her Meritain Health plan, Sofia has Meritain Health Pharmacy Solutions and the CARE Program. As she was pondering what to do, a CARE specialist was already busy at work behind the scenes. While reviewing her member information, her CARE specialist had discovered the change in employer coverage. He deduced right away  Sofia would need some support in affording her medication going forward.

Realizing time was of the essence, he dug into researching a few options. His efforts uncovered an available patient assistance program he thought might be perfect for Sofia. He submitted her member information to see if she could be accepted into this program. She was!

By enrolling in this assistance program, Sofia will receive a year’s worth of the medication she needs at no cost to her. The CARE specialist wasted no time in calling her to let her know.

Sofia was working in her garden when she received the good news. She almost couldn’t believe her good fortune. She’s so grateful to have Meritain Health and the compassionate support of her CARE specialist by her side.


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.