Are you on Drugs?

If so, this article is for you.

TIP: Don't overlook the benefit of buying drugs from Canada before it becomes our 51st state!

Suppose for a moment that your doctor prescribed a very expensive maintenance medicine such as Ozempic, Nurtec, or Xarelto. Expensive drugs such as these are categorized as Tier 4 drugs and are rarely covered by health insurance, costing patients as much as $1,000 per month and more. If you find yourself in this situation, the first thing to do is contact me to see if you qualify for a Patient Assistance Program (PAP). It costs nothing to find out, but we will discuss this more in a moment. However, since qualifying for PAP is based on a combination of income and household size, we will first explore other options in this article. In real life, we will explore the PAP first.

Many Americans turn to Canadian pharmacies to purchase prescription drugs at significantly lower prices than in the U.S., often due to differences in patent laws. In Canada, pharmaceutical companies’ patents sometimes expire earlier than in the United States. This allows Canadian pharmacies to sell generic versions of expensive brand-name drugs long before they become available as generics in the U.S. Generics are equally effective and undergo rigorous testing, but they cost much less because they don’t carry the same research and marketing expenses as brand-name drugs. Furthermore, Canadian pharmacies streamline the process, ensuring that medications go straight from the manufacturer to the patient’s doorstep. This direct supply chain eliminates additional middlemen, which can drive up costs in the U.S. healthcare system.

A client was paying out of his nose for Xarelto before discovering he could purchase the generic version from Canada for only $28 monthly. Because of his income level, he doesn't qualify for the Patient Assistance Program (described below) and as of this writing, the generic version isn't available in the United States.. His doctor sends his prescription to Canada Drugs as if it were a local pharmacy. Canada Drugs instructs the manufacturer to ship the medicine directly to the patient. The manufacturer is in the United States in this case. The customer service number for Canada Drugs rings to an office in Florida (the last time I checked). In other words, the only thing that goes to Canada is money. There is more than one Canadian Pharmacy. In addition to Canada Drugs, Canada Drug Warehouse, Canada Drugs Direct, Canada Pharmacy Depot, and probably more. 

For those who struggle to afford essential medications, Canadian pharmacies offer a reliable and cost-effective solution, providing high-quality medicines while bypassing some of the financial barriers that exist in the American pharmaceutical market.Spending thirty minutes doing a little internet research and making some phone calls might save you a boatload of money. 

Another Option to InvestigateThere is a rich guy in Dallas; what's his name? Oh yeah, Mark Cuban. Well, anyway, he started an online pharmacy called Cost Plus Drugs (https://costplusdrugs.com/). His business model is selling all pharmaceuticals with a 15% markup. I don't personally know of anyone who has benefited from this site, but it's worth checking out if Canada Drugs and the PAP haven't worked out for you. 

Another option is to search for coupons using your pharmacy discount card's app or website. If you have a policy with Philadelphia American, you already have the best pharmacy discount card available (Scriptsave), but if you don't, check out www.goodrx.com. One of my clients has asthma and must have an expensive inhaler that is not covered by insurance. He uses the website associated with his discount card to search for his inhaler. The search results will show the price to be three or four hundred dollars per month, but there will be a coupon that he can download and take to a specific pharmacy, such as CVS, to get his inhaler for only $40. My client explained that the pharmacy that accepts the coupon will change every few months, but he's been getting his inhaler for $40 for years using this method. 

Speaking of Philadelphia American pharmacy benefits, remember that you can file for your prescription reimbursement benefit regardless of where you purchase your medicine. You can use another discount pharmacy card such as Goodrx, buy your drugs from Canada, Costco, or wherever and still file for reimbursement. 

Speaking of Costco... Check out Costco's mail-order drug program while you are researching. You don't have to be a member of Costco to use the Costco Pharmacy.

Now, let's talk about the Patient Assistance Program. I can now provide a new service: determining your eligibility for free and enrolling you if you qualify. To qualify, your income must be below a certain amount, which depends on your household size... but don't assume, especially if you have three or more in your household. Because here's the kicker: your income is based on what you make at the time of your application. They will want to see your last two pay stubs or previous year's W-2. If your income was lower last year, use the W-2. Use your two most recent paystubs if your income has been low for the past couple of paychecks. If you are retired and have no income at all, we can state that on the application and guess what? You qualify, that's what. But what if you don't get paychecks or a W-2 because you are self-employed? The following is how the founder of the company providing access to this service answered that question:

• To verify income for the Patient Assistance Program (PAP), you simply need to provide a snapshot of the last two income deposits into your bank account. This amount can then be multiplied to estimate your annual income.

• Please note, the manufacturers are not overly strict about having an exact figure—they just need a general snapshot of your income for the current calendar year. Additionally, they are very understanding of individuals who are 1099 workers or self-employed. These programs are specifically designed to accommodate the unique challenges of fluctuating incomes often associated with self-employment.

You will know within minutes of working with me whether you qualify or not. If you qualify, you can pay $139 the first month and then $48 each subsequent month (except the first month of each year you pay the $139), then your medicine will be shipped straight from the manufacturer to you for no additional cost. And that's not all. Once you are on the PAP, you can add other medicines to receive at no additional cost. I helped a client get Nurtec under this program. While enrolling her, I noticed that one of the medicines that she could have added is Adderol, which tells me that the additional drugs don't necessarily have to be really expensive. 

Darryl Breland

Breland Benefits and Insurance