2. CORT First Friday September 5, 2008 Access to Prescription Medications: A Promise Met or A Dream Deferred Eugene R. King Ohio State Legal Services Association

3. For many Americans, prescription medications are increasingly: Important to treatment Costly (twice the rate of inflation) Difficult to obtain

4. Access to, and paying for, prescription medications is a challenge for almost all low-income Americans.

5. Normally, my approach to health care advice is: Get care Figure out how to pay for it afterwards

6. With prescriptions, it is more complicated: Get a prescription from a doctor Figure out how to pay for it — cost, co-pays, etc. Fill the prescription

7. doctor Emergency room FQHC Health Departments Free clinics VA Without a prescription, you’ve got nothing. The first hurdle: Getting a prescription: (with or without insurance)

8. So now you have a prescription … How do you fill it?

9. Unlike most medical providers, pharmacies require payment prior to providing the service.

10. If you have insurance, you may be covered. Medicaid Medicaid with Spenddown Medicare – Part D (beware the doughnut hole) Private Insurance VA

11. But, you may still have co-pays and deductibles.

12. What if you do not have insurance?

13. Are you sure you don’t have insurance?

14. Samples Emergency rooms Hospital charity programs FQHCs Free clinics Patient assistance programs Phrma — www.pparx.org/intro.php If you really don’t have insurance

15. Big box discounts –WalMart –Kroger –Target Discount programs –Best Rx — www.ohiobestrx.org –AARP –Michigandrugprices.com –Wvrx.org

16. Some charitable organizations have prescription assistance programs. American Cancer Society American Heart Association American Diabetes Association Local charities

17. there is MasterCard. For everything else,

18. Formularies limit covered medications Formularies may favor generics Formularies can change at any time Beware formularies

19. If you have insurance, make sure your doctor knows so she can prescribe within the formulary.

20. If you don’t have insurance, make sure your doctor knows so she can give you samples or prescribe the lowest cost appropriate medication.

21. If you have Medicaid with a Spenddown and do not need monthly office visits or lab work –Fill your prescription at the beginning of the month and again at the end of the month and forget about meeting Spenddown for the next month –Medicaid allows refills when 80% of the prescription has been used (check local Medicaid laws)

22. There may also be mail order or multi-month prescription options that will reduce costs

23. In the end, none of these strategies may work, but I encourage you to keep digging. Thanks—