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Published on August 13, 2018

Troubled by the high cost of your prescription?Troubled by the high cost of your prescription?

Henry Fuller of Brewster is very grateful for the help given to him by the Specialty Pharmacy staff at Cape Cod Healthcare (CCHC), who make sure he receives the medication that may give him a few more years with his wife, Nancy.

Fuller, 86, was diagnosed with prostate cancer 20 years ago. While his prostate-specific antigen (PSA) test remained level until 2016, it began to climb after that and, by November 2017, it had risen to an alarming level. Tests showed the cancer had spread to his lymph nodes.

“My doctors told me this decreased my life expectancy appreciably,” he said.

Fuller’s Cape Cod Hospital oncologist, Jeffrey Muler, MD, prescribed Zytiga, a chemotherapy drug which treats prostate cancer that has spread. But Fuller was sure could not afford the $1,800 monthly cost for the drug.

That’s when Michael Anastasia, CPhT, program manager for the CCHC Specialty Pharmacy, stepped in to help find financial assistance for him. Anastasia located a non-profit organization that initially covered most of the drug’s cost, and subsequently another organization that covered the entire cost.

“I had to pay $200 for the first prescription,” said Fuller. “In January, that source dried up and then Mike found another that will cover the entire cost for the rest of 2018. Now, I’m not worried about paying for it.”

Fuller is one of almost 1,000 patients Anastasia and CCHC community pharmacy manager Courtney Kelly, PharmD, CSP, have helped in many ways since the Specialty Pharmacy program began in 2017.

“Specialty medications are generally for people with complex conditions that require a lot of special support and coordination,” said Kelly. Some of these conditions include Hepatitis C, HIV, oral chemotherapy, rheumatology, arthritis, psoriasis and Crohn’s disease.

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Patients may have challenges with the cost of a medication or access to it, and that’s where the Specialty Pharmacy can help, she said.

“Some of these co-pays are thousands of dollars the patient is responsible for, depending on the type of insurance, and that could definitely be a limitation to access,” said Kelly. “We help them with the paperwork for prior-authorization, the appeals process when it’s not approved – which can be lengthy – and finding funds to cover the cost if the insurance company doesn’t cover it.”

Some Hepatitis C medications can cost between $23,000 and $30,000 per month, according to Anastasia.

“That’s about $1,000 a day for one pill. Some oncology therapies can run about $10,000 per month and the rheumatology medications, Humira and Enbrel, are about $5,000 per month. And some co-pays can run around $2,400 per month,” he said.

Painstaking Research

Because the cost of some drugs are so high, it often takes a village to get them covered, which involves paperwork that takes a huge amount of time to complete. It is a challenge both Anastasia and Kelly regard as their mission.

“We are part of the team of providers for our patients,” said Kelly. “We make a difference in our patients’ lives and care about how they are doing on their medications. They are incredibly thankful.”

Anastasia painstakingly researches non-profit organizations like the Patient Advocate Network (PAN), the Patient Advocate Foundation, (PAF) and Cancer Care to get financial assistance for patients. If they don’t have funds to help, they will provide links to other resources, he said.

While the activities of the Specialty Pharmacy can appear almost seamless to patients, there is much that goes on behind the scenes. Among the things Kelly and Anastasia do on a daily basis are:

  • Work closely with specialists and providers to fill out prior-authorization paperwork for insurance companies.
  • Develop personal care plans for patients and follow-up with education, monitoring of treatment and support.
  • Call patients five or six days before refills are due to ensure that patients continue to take their medications as directed.
  • Research funding to help with co-pays and costs of the prescriptions.
  • Work with patients’ providers to obtain prescriptions for an appropriate alternative medication when the brand isn’t covered.

Kelly and Anastasia are available 8 a.m. to 5 p.m. Monday through Friday, and can be reached at 508-862-5905. A pharmacist can be reached at the same number after hours to answer any questions, provide support.

Prescriptions from the Specialty Pharmacy can be mailed or delivered at no cost. They can also be picked up at any of the CCHC retail pharmacies, which are located in the lobbies of Cape Cod and Falmouth hospitals, at Stoneman Outpatient Center in Sandwich, or at Fontaine Outpatient Center in Harwich. They can also be delivered to a patient’s physician’s office.

If a patient’s insurance only allows a specific pharmacy to fill their medication, Kelly and Anastasia work with that pharmacy to make sure you get your prescription in a timely manner.

Thanks to Kelly and Anastasia’s financial assistance work, Fuller is continuing to take the Zytiga and his PSA level had dropped to 10 at his last visit.

“I feel good, thanks to Mike,” he said of Anastasia.