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More Than Just Care: Medication Prices Dictate Quality of Care

hand holding medicine tracker and retrieving pills from it

Social Determinants of Health 3 - Prescription Affordability

By Network Health pharmacy team
Originally published on 12/29/2021 at 1:30 p.m.

Continuing our series on the social determinants of health, we’re looking at one of the most significant factors in health care and one that has become a lightning rod for medical discourse – the cost of medication.

The ability to afford prescription medication costs is a factor that can lead to the successful management of chronic health conditions. At the same time, the inability to afford prescription medications can lead to disease progression, complications and an overall reduction in quality and quantity of life. In addition, as diseases progress, the need for more and potentially higher-cost medication increases.

At Network Health, we want our members to afford their needed prescription medications to live their happiest and healthiest life. Network Health is creating a compilation of articles for members that contain tips and tricks to controlling medication costs.

General Tips and Tricks to Reduce Medication Costs

By Beth Coopman PharmD., pharmacist at Network Health

With medication costs being a significant barrier of care for some, finding ways to reduce them is important. Here are some ways to get the most out of your health plan and leverage your benefits to help reduce prescription drug costs.

  1. As a Network Health member, you have the option to speak with a Network Health pharmacist about your medication cost concerns by doing either of the following.
  2. Know your benefits. For some medications, using Express Scripts Mail Order Pharmacy can be less expensive. Choosing a preferred pharmacy, like Walmart, Walgreens, Pick-N-Save, Smith, Omro and Meijer can also reduce copays for Medicare members.
  3. Know your formulary. Network Health places lower-cost and high-value medications favorably on the covered drug list (also called the formulary).
    • As an example, Network Health offers an inhaler regimen that doesn’t break the bank. Proair® HFA, Ventolin® HFA and Proventil® HFA are used as needed for fast-acting relief of breathing issues, such as wheezing, shortness of breath and coughing. All three of these agents are now available in generic versions, called albuterol HFA.
    • Daily maintenance inhalers, Dulera®, Symbicort® and Breo contain both a steroid and a long-acting airway dilator to maintain control of breathing conditions. Generic Symbicort is now available too, yet lower-cost alternatives exist. Generic AirDuo® (fluticasone/salmeterol) was the first generic combination inhaler and is in the same family of medications as Dulera, Symbicort, Breo and its generic. There is now a generic for Advair Discus® as well.
    • Talk to your doctor or pharmacist about lower-cost albuterol HFA or generic AirDuo to start saving on your next prescription refill.
  4. The Real-Time Benefit Tool (RTBT) allows a provider to review the cost of a medication before sending the prescription to the pharmacy and may be available within your clinic’s computer systems. Next time your provider orders a new prescription, ask if the clinic has the RTBT tool or a comparable program to share the cost of the drug being considered, including prices at different pharmacies and alternative options. Having this information at hand during the clinic appointment can help open the dialogue as to whether an alternative and lower cost, medication can be considered.
  5. In some instances, you can save money if your provider prescribes a higher dosage of your prescription and instructs you to split the tablet in half. Invest in a high-quality pill-splitter that can be purchased at your local pharmacy because the pill-splitter helps ensure the tablets are split precisely in half. Do not split tablets in half without your provider adjusting the dosage so you continue to take the prescribed dose.
  6. Patient assistance programs may be available through the manufacturer. Visit rxassist.org to find more information about a specific medication.
  7. Occasionally, providers have access to free medication samples or information about a free month supply you may ask about.
  8. Never pay full cash price for a prescription. Websites like com allow you to see prices at different pharmacies and may offer coupons to lower medication costs. This maybe the most useful for medications not covered on your plan.
  9. Discuss over-the-counter medications, vitamins and herbal products you are taking with your provider. Sometimes these products can be costly with little proof of benefit.
  10. Store-sponsored generics can save you money, especially for diabetic supplies. Ask your pharmacist about store-sponsored insulin pen needles to save money. In addition, Relion brand insulin products, like Novolin and now Novolog, are a fraction of the price at Walmart compared to other pharmacies. Those with high deductible plans may consider getting store brand diabetic testing supplies, like Relion brand glucometer, test strips and lancets.
  11. Medicare members may be eligible for extra help to pay for prescription drug premiums and costs. To check qualifications for extra help, members can call 1-800-MEDICARE or 1-800-633-4227 (TTY 1-877-486-2048), 24 hours a day, seven days a week.
  12. Medicare members can apply for SeniorCare of Wisconsin. SeniorCare is a wonderful secondary coverage drug plan, complementary to your primary coverage with Network Health Medicare Advantage plan. Having both Network Health Medicare Advantage and then adding on Senior Care of Wisconsin is most beneficial to members with higher drug costs. To apply for SeniorCare of Wisconsin, you can call your county Aging and Disability Resource Center (ADRC). To be eligible for SeniorCare, you must meet these requirements:
    1. Wisconsin resident
    2. 65 years of age or older
    3. $30 annual enrollment fee per person
    4. Annual earned income determines the level of coverage
    5. Assets, such as insurance policies, home property, etc., are not counted

Cause and Effect: Generic Utilization and Cost Control

By Beth Coopman PharmD., pharmacist at Network Health

Did you know the main difference between a generic drug and a brand name drug is the price? Why the huge price difference? A Nielson estimate explains drug companies spent approximately $5.2 billion in 2015 advertising brand medications directly to consumers through TV, digital ads and written media. Costs for brand name products are also increased by providing free samples for prescribers to start patients on the brand medication and the availability of regional drug representatives who promote and educate practitioners about the brand name products. Research and development (R&D) is another area that increases costs for brand-name drug companies.

All generic drugs approved by the FDA have the same high quality, strength, purity and stability as brand-name drugs. Tablet fillers, binders or dyes make up inactive ingredients of pills and are the only components that can be different between a brand and generic drug.

Some drug manufacturers make both brand and generic versions at the same facility. The pharmacy staff here at Network Health researches and educates our members when this occurs so the generic made by the brand manufacturer can be trialed when there are sensitivities to other generic manufacturers.

Generic medications bring competition to the market which drives prices down. Generally, having more generic manufacturers in the market lowers medication costs. Without the billions spent on advertising, drug samples, R&D and coupon cards, generics do not have the overhead that consumers pay for with brand name medications.

Below is a table comparing the drastically different costs of brand name medications and their generic equivalent. Notice some of the newer generics have less of a price difference but as more manufacturers produce the newly available generic the overall generic price drops more noticeably from the brand name price. 

Brand Name

Brand Cost*

Generic Name

Generic Cost*

Abilify 20mg

$1,000

Aripiprazole

$30

Adderall 20mg

$430

Amphetamine/Dextroamphetamine

$35

Advair 250/50 Diskus

$400

Fluticasone/Salmeterol

$200

Amitiza 24MCG

$370

Lubiprostone

$320

Lyrica 75mg

$500

Pregabalin

$25

NuvaRing

$153

Eluryng

$130

Travatan Z Eye Drops

$200

Travoprost

$130

Vascepa 1 GRAM

$340

Icosapent Ethyl

$300

Zytiga 500mg

$11,000

Abiraterone

$9,000**

*Estimated monthly prices for brand and generic medications.

**Note: Using #4 of the 250mg generic tablets is the best value at $6600

Educate yourself to be an informed consumer. Know how choices impact plan costs and periodically ask your doctor or pharmacist about cost and alternatives for prescriptions because opportunities change over time.

Your Network Health pharmacist is available to help answer your medication-related questions. Email pharmacist@networkhealth.com or call pharmacists Gary, Beth, Sarah and Anna at 920-720-1287 (888-6651246) Monday- Friday from 8 a.m. to 5 p.m. with medication-related questions.

Pharmacy Tips on your Inhalers for Asthma or COPD

By Anna Peterson Sanders PharmD., pharmacist at Network Health

Treatment of chronic obstructive pulmonary disease (COPD) and asthma can be a financial burden for many people. However, chronic therapy is vital in maintaining one’s health, delaying the progression of the disease and preventing costly emergency room visits or hospitalizations. Within the past couple of years, generic inhaler options have become available, providing patients with lower-cost options. While three generic combination inhalers (comprised of an inhaled corticosteroid and a long-acting beta-agonist) are now listed on the Medicare and Commercial formulary, they vary widely in ingredient cost. For many of our members, choosing an inhaler regimen based on both tier placement and ingredient cost can save them in the long run.

Below are a few key takeaways regarding generic inhalers.

  • Fluticasone-Salmeterol (generic for AirDuo) represents the lowest ingredient cost to members.
  • All contain the same ingredients – fluticasone and salmeterol.
  • All are available in low, medium and high potency strengths.
  • Conversion from one to another may require a new prescription.
  • The table below lists inhaler prices from lowest to highest

Medication

Strength (potency)

Ingredient Cost*

Commercial Tier

Medicare Tier

Fluticasone-Salmeterol

(generic for AirDuo RespiClick)

55-14 mcg (low)

$90

1 (Generic)

 

113-14 mcg (medium)

$90

2

232-14 mcg (high)

$90

 

Fluticasone-Salmeterol diskus (generic for Advair Diskus)

100-50 mcg (low)

$160

1 (Generic)

 

250-50 mcg (medium)

$200

2

500-50 mcg (high)

$250

 

Wixela

(generic for Advair Diskus)

100-50 mcg (low)

$160

1 (Generic)

 

250-50 mcg (medium)

$200

2

500-50 mcg (high)

$250

 

Advair HFA

45-21 mcg (low)

$325

2 (Brand drug)

 

115-21 mcg (medium)

$395

3

230-21 mcg (high)

$520

 

Advair Diskus

100-50 mcg (low)

$310

2 (Brand drug)

 

250-50 mcg (medium)

$400

4**

500-50 mcg (high)

$520

 

AirDuo RespiClick

55-14 mcg (low)

$350

3 (Non-preferred drug)

 

113-14 mcg (medium)

$350

4**

232-14 mcg (high)

$350

 

*Estimated monthly prices for brand and generic medications using claims data.

**Non-formulary on the NetworkCares Medicare Advantage Plan

Be sure to check your formulary at networkhealth.com “Look Up Medications” for coverage if other inhalers are prescribed for asthma or COPD. Many inhalers have similar active ingredients so ask your physician about prescribing a more affordable but equally effective inhaler.

Your Network Health pharmacist is available to help answer your medication-related questions.

Email pharmacist@networkhealth.com or call pharmacists Gary, Beth, Sarah and Anna at 920-720-1287 (888-6651246) Monday- Friday from 8 a.m. to 5 p.m. with medication-related questions.

How Can Infusion and Injectable Medication Costs be Reduced?

By Anna Peterson Sanders PharmD., pharmacist at Network Health

Injectable medications are expensive. Many people often wonder about ways to save money when an injectable medication is necessary for medicinal therapy.

For medications that are infused intravenously (IV), getting care at home can save money, improve convenience and utilize specially trained nurses who have experience giving people infusions every day.

Home care infusion nurses provide one-on-one infusion care in the convenience and comfort of your own home, limiting your exposure to other people and environments.

For other non-IV injectable medications, as additional safety data becomes available, you may see medications that were previously only injected at a doctor's office move to self-administration at home, which also can save money and improve convenience.

Some examples of medications that were previously only injected at a doctor’s office that are now available for self-administration at home are Actemra, Benlysta, Cimzia, Dupixent, Fasenra, Hemlibra, Nucala, Orencia, Xolair and others. The list of medications available for self-administration at home is periodically updated so check with your prescriber if your injectable medication is included. Many advantages can be seen with self-administration:

  • Member convenience: Medications can be obtained through home delivery, thereby eliminating the need to visit a pharmacy in person. Additionally, the member is saved the time and cost of visiting their provider’s office.
  • Cost-effective benefit: In the majority of situations, shifting site of care to the home environment, as well as providing the medication through the pharmacy benefit, provides the most cost-effective route for all parties involved.
  • Socially responsible: With coronavirus and its variants, social distancing can be reinforced through self-administration of medications. Fewer patients will be entering the provider’s offices, thereby slowing the spread of viruses and ensuring we are responsibly utilizing the provider’s time and resources to treat the sick.

Injectable medications, often classified as specialty medications, can be obtained through the following channels based on your type of Network Health plan.

  • Commercial (Coverage through your employer): Accredo Specialty Pharmacy
  • Healthcare Exchange (HIX, ACA)
    • Northeast Wisconsin: Accredo Specialty Pharmacy
    • Southeast Wisconsin: Froedtert Specialty Pharmacy
      • If Froedtert does not stock the Specialty medication, then medication will be obtained through Accredo Specialty Pharmacy
    • Medicare: Any contracted pharmacy willing and able to supply specialty medications

If you are interested in pursuing lower cost and convenient home administration of your injectable drug, ask your provider about your options. Network Health strives to deliver convenience, safety and value to our members.

Handling the High Cost of Insulin Use

By Anna Peterson Sanders PharmD., pharmacist at Network Health

Prices for diabetes medication have been skyrocketing, leading many consumers to face the difficult decision of whether they can afford their monthly medications.

Studies show that high medication costs can lead to poor adherence, like skipping or rationing doses. When it comes to diabetes medications like insulin, poor adherence may lead to long-term complications, hospitalization or even death.

When the stakes of not using the medication are high, but so is the price, what should you do? Consider the suggestions below, and if you are still struggling, please reach out to Network Health for help.

  1. Lifestyle modifications and Metformin. Reducing calorie intake, losing excess weight and regularly exercising can help improve blood sugar control. Network Health offers support for lifestyle changes through health and wellness programs. Visit networkhealth.com and select Wellness Programs to learn more. In addition, Metformin is low cost and high-value first-choice medication for type 2 diabetes and prediabetes. Metformin is well known for benefits such as weight loss and potentially slowing disease progression. It’s important to consider that as blood sugars increase so do medications costs. Working hard to control blood sugars early on can benefit both overall health and medication costs as well.
  2. Shop around. Different pharmacies can have varying medication prices, so shop around to find the lowest cost options available. Some helpful websites include goodrx.com (for any type of insurance) and Medicare.gov (for Medicare members – start with “Find health & drug plans”). In addition, brand Novolin 70/30, N and R insulin vials cost about $26 at Walmart versus about $165 at other pharmacies. A box of ReliOn brand Novolin 70/30, N and R Flexpen insulin costs $43 at Walmart versus $260 at other pharmacies. Novolog can cost upward of $280 per vial and $550 per box of Flexpens. Walmart just announced a ReliOn Novolog option at $73 per vial and $86 per box of Flexpens. ReliOn Novolin and Novolog insulin is the exact same product as the Novo Nordisk brand Novolin and Novolog but made for Walmart through a partnership to provide a lower-cost product.
  3. Store-sponsored generics can save you money, especially on diabetic supplies. Ask your pharmacist about store-sponsored insulin pen needles to save money. ReliOn over-the-counter pen needles retail for about $9 for a 50-count box. Other low-cost store brand diabetic testing supplies, like ReliOn brand glucometer, test strips and lancets, can be purchased without using your Network Health benefit.
  4. Generic diabetes medications. Here is a list of lower-cost generic oral diabetes medications you may ask your provider about Metformin, Glipizide or Glimepiride, Pioglitazone, Nateglinide, Repaglinide, Miglitol and Acarbose. Novolog and Novolog 70/30 insulin now have generic availability and may save you money. Insulin Aspart is the generic for Novolog and Insulin Aspart Protamine- Aspart 70/30 is the generic for Novolog 70/30.
  5. Be savvy when opting for lower-priced insulins. Some lower-cost recommendations that you and your provider should discuss include the following.
  • NPH insulin (e.g. Novolin N) instead of the more expensive long-acting insulins (e.g. Lantus, Levemir, or Tresiba)
  • Regular insulin (e.g. Novolin R) instead of the more expensive fast-acting insulins (e.g. Novolog)
  • Use formulary products. Check your formulary to see what products are lowest tiered.

Medication Costs of Common Insulins

Medication

Strength

Quantity

Ingredient cost*

Basaglar Kwikpen

100 units/ml

5x3ml pens (one box)

$300

Lantus SoloStar

100 units/ml

5x3ml pens (one box)

$400

Levemir Flexpen

100 units/ml

5x3ml pens (one box)

$450

Tresiba Flextouch

100 units/ml

5x3ml pens (one box)

$500

Novolog Flexpen

100 units/ml

5x3ml pens (one box)

$550

Novolog

100 units/ml

10 ml vial

$280

Insulin Aspart (generic Novolog) Flexpen

100 units/ml

5x3ml pens (one box)

$260

ReliOn Brand Novolog

100 units/ml

10 ml vial

$73

ReliOn Brand Novolog Flexpen

100 units/ml

5x3ml pens (one box)

$86

Novolog 70/30 Flexpen

100 units/ml

5x3ml pens (one box)

$550

Insulin Aspart Protamine- Aspart 70/30 (generic Novolog 70/30) Flexpen

100 units/ml

5x3ml pens (one box)

$260

Novolin N

100 units/ml

10 ml vial

$135

Novolin N Flexpen

100 units/ml

5x3ml pens (one box)

$260

Novolin R

100 units/ml

10 ml vial

$135

Novolin R Flexpen

100 units/ml

5x3ml pens (one box)

$260

Novolin 70/30

100 units/ml

10 ml vial

$135

Novolin 70/30 Flexpen

100 units/ml

5x3ml pens (one box)

$260

ReliOn Brand Novolin N

100 units/ml

10 ml vial

$26

ReliOn Brand Novolin N Flexpen

100 units/ml

5x3ml pens (one box)

$43

ReliOn Brand Novolin R

100 units/ml

10 ml vial

$26

ReliOn Brand Novolin R Flexpen

100 units/ml

5x3ml pens (one box)

$43

ReliOn Brand Novolin 70/30

100 units/ml

10 ml vial

$26

ReliOn Brand Novolin 70/30 Flexpen

100 units/ml

5x3ml pens (one box)

$43

* Ingredient cost estimated from claims data. Price subject to change.

  1. Find patient assistance programs. Check with the drug manufacturer about programs that may help with the medication cost. org is a useful resource. The Juvenile Diabetes Research Foundation (JDRF) and American Diabetes Association (ADA) provide multiple avenues for patient assistance, including options for those that do not qualify for manufacturing assistance.
    *Lilly Diabetes Solution Center 1-833-808-1234 is a very helpful resource to request a voucher for free medication, such as Humulin both U100 and U500, Humalog, Trulicity and Basaglar. You can also request a Patient Assistance Programs application to get free medication for the rest of the year.
  1. Use Medication Therapy Management. Medicare members may be eligible for a comprehensive medication review (CMR) with a Network Health pharmacist. The discussion gives you an opportunity to review your medications and identify potential cost-saving strategies. Even if you don’t qualify for this program, or you are on a commercial or health exchange plan, feel free to call 920-720-1287 or 888-665-1246, Monday–Friday from 8 a.m. to 5 p.m. or email anytime at pharmacist@networkhealth.com to speak with a pharmacist for a medication review
  2. Medicare members may be eligible for Extra Help to pay for prescription drug premiums and costs. To check qualifications for Extra Help, members can call 1-800-MEDICARE or 1-800-633-4227 (TTY 1-877-486-2048), 24 hours a day, seven days a week.
  3. Medicare members can apply for SeniorCare of Wisconsin. SeniorCare is a wonderful secondary coverage drug plan, complementary to your primary Network Health Medicare Advantage plan. Having both Network Health Medicare Advantage and then adding on Senior Care of Wisconsin is most beneficial to members with higher drug costs. To apply for SeniorCare of Wisconsin, you can call your county Aging and Disability Resource Center (ADRC). To be eligible for SeniorCare, you must meet these requirements:
    1. Wisconsin resident
    2. 65 years of age or older
    3. $30 annual enrollment fee per person
    4. Annual earned income determines the level of coverage
    5. Assets, such as insurance policies, home property, etc., are not counted
  4. Contact your local Aging and Disability Resource Center (ADRC). The ADRC can be helpful resources not only for health care but also for assisting with other needs such as transportation, nutrition and meal programs. Find a local center near you.

While prescription drugs may seem unaffordable, the above resources exist to help you get the medicine you need and overcome a significant social determinant of health.

For more information, contact us today.

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