Drug costs are disproportionately higher in the U.S. than in other countries, and they are continuing to rise.
Pharmaceutical companies have monopolized our prescription drug market. Among other systemic drivers, patents and exclusive marketing rights granted by the FDA block lower cost generic drugs from entering the market and lead to price inflation.
These high costs are a substantial barrier for many. Fortunately, CCHI has a new tool, VIVOR, that can help you get more affordable prescriptions.
After we build your unique profile, VIVOR matches you with underused, money-saving resources.
There are two main types of assistance offered through VIVOR: manufacturer assistance and foundation assistance.
Manufacturer assistance is help available directly from the company that makes your medication. For these programs, you must be commercially insured, but there are typically no income guidelines. You could get help with the copay, coinsurance, or deductible costs for your prescription drugs. Some manufacturers even offer support for the out-of-pocket costs of infused drugs.
Foundation funding is offered by nonprofit organizations. Because these organizations rely on donations, the availability of funding can be unpredictable. CCHI receives regular updates on the opening and closing of funds. In order to be eligible for help, you must meet income guidelines based on the Federal Poverty Level (FPL) and have immediate financial need. The grants can cover the out-pocket cots of your medication, insurance premiums, or travel costs and other treatment-related expenses.
For both of these assistance options, benefits and eligibility vary for each program.
VIVOR can also match you with patient assistance programs (PAPs) that offer free or replacement medication. Typically these programs are intended to support uninsured people and those whose health plan does not cover a particular brand-name drug. You may also qualify if you are on Medicare but no foundation funding is available for your diagnosis. Depending on your condition, the free medication or replacement products can be shipped to the infusion center, doctor’s office, or directly to your home.
If you are struggling with the high cost of prescription drugs, we encourage you to reach out to us and set up a VIVOR profile. In many cases, prescription drugs lead to a better overall health outcome and even lower overall health care costs.
For example, one of our clients asked us for help with lowering the cost of her Tymlos and Trulicity medications. Without insurance, Tymlos can cost $1800 or more per injection pen, and each pen only contains 30 doses. The client’s Medicare Part D covered some costs, but she was still paying $500 per month for Tymlos alone. Trulicity lists at $800 per month, which added to her financial strain.
Fortunately, she qualified for manufacturer assistance programs in VIVOR for both medications. Through Together with Tymlos and Lilly Cares Foundation, our client gets her medications for free. She saves $1300 each month.
Want more information on how we are combating high drug costs? We are currently working on legislation for the 2021 Colorado Legislative Session to establish a Prescription Drug Affordability Board, which would address high prescription drug costs and provide opportunities for diverse stakeholders to negotiate affordability challenges and lower costs for consumers.
Join our coalition here or email our Policy Manager, Isabel Cruz, at icruz@cohealthinitiative.org to get involved and subscribe to our updates. If you have a story about how high drug costs has impacted your life or your loved ones that you would like to share, visit our story collection page or reach out to chat with us. We are always looking for advocates and leaders like you to join our efforts and help us advance health equity–we’d love to hear from you!