Insulin Costs Too High? Not to Fear, Patient Medication Assistance Programs are Here!

You notice that you have been extra thirsty lately, that you are taking frequent trips to the bathroom, and your vision is much blurrier than it was before. Your hands and feet tingle. You meet with your physician to see what the issue is, and after several tests, you are diagnosed with type 2 diabetes. This is life-altering news, but your doctor says it can be managed with a healthy diet, exercise, and daily insulin injections. The insulin should be super easy to get, right? You have health insurance; it should not be a problem for you to run over to the pharmacy and pick up your insulin with a minimal copay.

However, for many people in America, particularly the patients who I serve at the Birmingham Free Clinic in Pittsburgh, PA, it is not easy to get their insulin. In fact, they cannot get their insulin without paying full out-of-pocket prices totaling hundreds of dollars per month because they do not have health insurance coverage and/or do not have prescription medication coverage as part of their healthcare plan. Without insulin, a person with type 2 diabetes can develop damage to their kidneys, eyes, and nerves, which can significantly impact their quality of life and be life-threatening. These patients need insulin to survive and lead a healthy life, but how do they get it?

Thankfully, there are programs called Patient Medication Assistance Programs, or PMAPs, that allow patients with no or limited prescription drug coverage to gain access to their medications for free. Many of our patients need help with these PMAPs because they have low health literacy or are non-English speaking. This is where I come in as a Patient Navigator and Advocate for NHC Pittsburgh at the Birmingham Free Clinic host site. Part of my service is to fill out and process applications for PMAPs for many of our patients and send them to drug companies that produce medications like insulin. Once the drug companies receive the applications, they either request more information, approve, or deny the applications. Usually, the requirements are only that the patient has limited and/or no insurance and that they are below an income threshold that is based on the federal poverty line and the price of the medications. In order to process the applications, I need a prescription from our doctor and our doctor’s signature. I also need the patient’s signature, and I use this opportunity to educate our patient on what a PMAP is and how this provides them access to their medications. Additionally, the companies require income documents from the patient to ensure the patient is below the income threshold. These income documents could include a tax return, W2 form, social security benefits statement, pension benefits statement, or paystubs. Occasionally we have patients who do not file taxes and are paid only in cash. In this case, I write a letter to the company on the patient’s behalf stating who they work for, what they do, how much they make, and a general explanation of their income. These letters are vital, because if I did not do them as part of my service, the company would deny the patient’s application.

Once approved, I also coordinate medication shipments from the companies to our provider’s office, log receipt of all PMAP medications, and transport them from our office location to the clinic. Here, I let the pharmacist know that we received medications and I help store them in the fridge if needed or cabinets. I also maintain a calendar and spreadsheet at our office location that has every patient’s PMAPs on it and when they are due for a refill. I order all patients’ PMAP medication refills from the drug companies and respond to any communications from the drug companies.

My role is essential because through the PMAP program I am able to get patients the medication they need to manage their chronic illnesses and thrive. The medications we can apply for and provide for patients range from insulin, to inhalers, to mental health medications, and even medications for psoriasis! The PMAPs program is truly an asset to our clinic and alleviates the cost of medication barrier that affects many of our patients. I am so thankful that I get to play a small role in making medications more accessible for our patients!