Keith needed to keep his seizures from running his life. They had recently gotten worse, and his doctor prescribed a new medication to help keep them under control. So far it was working.
But there was just one catch.
His medication was very expensive. It took a significant chunk of each paycheck to cover it.
He knew the dangers of skipping his medication. A seizure could happen at any moment—at home, at work, while he was driving or even just walking down the street. If his seizures weren’t under control, it could put Keith and possibly those around him at risk.
Right now, he was only purchasing his medication week to week, as he could afford it. He was limping along financially. He hadn’t yet had to go without his new meds, but deep down he knew it was just a matter of time. He lived in fear of what could happen. Uncontrolled seizures could mean the loss of his driver’s license, the loss of his job… he didn’t like to think about it. But the price of the medication wasn’t sustainable.
Keith had access to the CARE Program through Meritain Health® Pharmacy Solutions, as part of his health care benefits. The program helps ensure he gets the best and most appropriate pharmacy care at the best possible prices.
A representative from the Meritain Health CARE Program knew something needed to change.
The CARE team was worried for Keith. They knew the risks of him going without his medication, and knew he needed it to maintain his quality of life. They got to work right away to find a solution.
First, the CARE pharmacist contacted Keith’s doctor, who needed to approve any changes to his prescription. Next, she found an offer through the drug manufacturer for a 28-day supply at no cost. However, she knew that would only help Keith for so long.
The CARE representative then found a copay assistance program, also through the manufacturer. This would provide Keith some cost relief; however, it would be exhausted after just two fills. The search continued!
Then it happened—the CARE representative found an open program called The Assistance Fund, or TAF, that would cover about $2,700 per year in medication costs. A CARE pharmacist also discovered Keith’s prescription was two tablets of a lower dose, when a single tablet of a higher dose would provide the same treatment with fewer pills. This would save more than $9,800 per year in costs to both Keith and his employer. All the solutions combined would help him tremendously with his medication costs.
Eager to share this good news, the CARE representative contacted Keith—he could barely believe what she was telling him. He would be able to continue his treatment and keep his life on track. He was beyond relieved. It felt like a miracle.
Keith is currently living his life with his seizures under control. He continues to take his medication and can afford it through the assistance he is receiving. He’s thankful for the CARE Program, which helped him right at the time he needed it most.
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 in any new or future case(s), as the result of each case depends upon many factors, including the facts of each case.
Case savings include managed savings and negotiated savings and follow guidelines prescribed by the Case Management Society of America (CMSA). Managed savings reflect avoidance of potential charges that are realized through the intervention/actions of the case manager. Negotiated savings reflect savings off actual charges that are negotiated by the case manager with an individual provider.
This material is for information only and is not an offer or invitation to contract. Health benefits and health insurance plans contain exclusions and limitations; see your plan documents for complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary and are subject to change.
