Saving the Day, and Probably a Lot More

ven though we see and hear first-hand stories from members every day, each is based in a different person’s life, family, health condition, financial situation … reality.

One recent example resembles that of so many patients with diabetes—dependence on insulin, plus a host of other medications for associated conditions. It also reflects the confusion and frustration consumers can experience with their pharmacy benefit, and how quickly the bottom can drop out on someone.

We think this email sums it up pretty well:

The confusion: Like so many consumers, this member likely didn’t realize that moving to a high-deductible health plan (mid-year) meant she had to bear the full cost of all her medications until that deductible was met.

The frustration: Judging by the email, it’s more like despair. That’s a common symptom when a person pays $35 out of pocket for a life-saving medication for years on end, and then suddenly it’s $900 per fill.

The reality: While one could argue that the member should have known the ramifications of her choice of health plan—assuming she had a choice—one might also ask, how is it that so many people are caught off guard in the same way. Maybe the bigger question is why insulin costs $900 per fill in the first place.

What really matters is this woman went six days without insulin while her blood sugar levels went through the roof. It’s as if the system told her, “Sorry you can’t come up with $900 today. Guess you’ll have to suffer, maybe even die.”

Going the Extra Mile, Plus Another Lap

If you look at the email closely, you’ll notice this member’s confusion, anger and despair is mistakenly directed at us. She thought we were her insurance company. But in fact, she was replying to a Savings Notification email from us. We send them to every member with an opportunity to save on their medications. What we never do is send them from a “no-reply” address. Because we want every member to have access to expert help and guidance right away, simply by replying to the email or calling our 800 number.

In this case, our software had analyzed her claims, knew her plan and deductible status had changed, automatically looked for savings opportunities, found one, and notified her about it. Our Savings Suggestion for Lantus®, a therapeutic alternative for her $900 Levemir®, was “only” $80 less. But $80 is $80, and unlike Levemir, Lantus had a manufacturer copay assistance program in place.

Back to the email. One of our certified pharmacy technicians replied to the member and explained that a) we aren’t her insurance company or pharmacy benefit manager, and more importantly b) there was a cheaper option with copay assistance available.

Unfortunately, that reply went unanswered by the member. We didn’t have her phone number, either. Normally, in situations like this, we would send a snail-mail Savings Notification to the member, but Gabby Orth, CPhT, from our Pharmacy Support team knew a diabetic might not be able to wait that long. After an exhaustive search, Gabby found a phone number and finally reached the member.

She was thrilled to learn that Lantus was not only cheaper in her plan but that the copay assistance coupon would actually bring her cost down to zero! (We’re not huge fans of copay coupons from a big picture standpoint, but they can be life-savers in situations like this and it’s our job to put them in members’ hands.)

If we hadn’t been able to reach her, would she even know about the cheaper insulin or that a copay coupon was available? What would paying $900 a month for three months do to her finances? Would she continue to ration insulin and suffer the consequences?

All we know is she can now get the medicine she needs to stay alive. She probably understands her health plan and pharmacy benefit better. And she likely trusts her insurance company a little more knowing they provide Rx Savings Solutions to their members.

All in all, that’s a pretty good day.