PMAPs: The hidden lifeline of a broken system

A question that has always haunted me is, “how do patients that are uninsured get medication or afford to pay for their medication?”. Whether on the news or social media, I would often see so many stories of patients that could not afford to pay for their insulin. At my host site, Birmingham Free Clinic, we see many patients who are in this same situation—especially our diabetic patients.

After a quick  search on Goodrx.com, I was faced with the ugly truth and reality of the out-of-pocket costs of insulin. Let’s take for example, Basaglar Kwikpen, one of the more common prescriptions I have seen used here in Birmingham. For just one box of Basaglar, a patient that is uninsured would pay about $400, or $250 if they use the Goodrx coupon. Imagining that  a patient goes through one box of Basaglar per month, the cost quickly rises to over $1,200 (or about $750 using the coupon) for a 3-month supply.

So how can, and how do patients who are uninsured get medications such as insulin, inhalers, or biologic* medications? Well, that’s where the Patient Medication Assistance Programs (PMAPs) of companies such as LilyCares, GSK, Abbvie, etc. come into play. These programs are put into place for patients that are 300-500% under the Federal Poverty Line and do not have prescription coverage. Patients receive a prescription from their doctor and fill out the application in order to receive that medication at no cost for one year. I spend approximately half of my time here at Birmingham managing our PMAP medication spreadsheet. Every week, I call for refill orders, send in new or annual re-enrollment applications, and finally, once the medications are approved and delivered, I label and store them.

There's an unexplainable rush of adrenaline that comes when we get an approval letter for one of our patients. These approval letters mean patients will get the medication they need without having the extra burden of figuring out how to pay for it or go without treatment due to costs. One such case was when I met “TB” during our dermatology clinic. He listened intently as I explained the PMAP process to him and how it would help him get the medication he needed for his new diagnosis. I assured him that I would take care of sending and keeping track of the application status, however, he seemed not too convinced that he would get approved. Yet, when I called him to say it was approved, he was overjoyed and told me this was “such great news!” Patient interactions like these make this part of my position so worth it. Our “PMAP torch” has been passed on from AmeriCorps member to AmeriCorps member year after year in Birmingham and it has been such an honor to be the one responsible for it this service year.

**Another shocking number for you: Humira, a common biologic agent that is used to treat rheumatoid arthritis costs $11,000, or about $6,500 using a Goodrx coupon.