When you're in pain, the last thing you want to think about is paying for your medicine. Yet money worries have stopped many people from getting the pain treatment they need. Talk with your oncology social worker if you have questions. He or she should be able to direct you to resources in your area. Here are some general tips:
When dealing with health insurance, you might want to:
- Call your insurance company and find out what treatments are covered. Sometimes insurance companies pay for only certain types of medicines. If the medicine you need isn't covered, your doctor may need to write a special appeal letter. Or your doctor may need to prescribe a different treatment.
- Ask if your insurance company can give you a case manager to help you with your coverage.
- Check to make sure that your plan will cover any specialists your doctor refers you to. If it does not, check with your insurance company to see which doctors are included in your plan. Ask your doctor to refer you to someone on your plan's list.
- Find out whether you have to pay copayments up front and how much they cost.
- Find out how you should pay your balance. For example, do you file a claim? Does the insurance company pay first? Or do you pay and get reimbursed?
- Tell the insurance company if you believe you've received an incorrect bill. You should also tell your doctor or the hospital or clinic that sent the bill. Don't be afraid to ask questions.
Government health insurance
Medicare is health insurance for people age 65 or older. However, people under 65 who are on kidney dialysis or have certain disabilities may also qualify.
Medicare Part B only pays for outpatient medicine given by a pump or by vein. It doesn't pay for pills, patches, or liquids.
Medicare Part D is a benefit that covers outpatient prescription medicines. It comes from private insurance plans that have a contract with Medicare. These plans vary in what they cost and the medicines they cover. Find out which medicines a plan covers before you join to make sure that it meets your needs. You should also know how much your copays and deductible will be.
Medicaid gives health benefits to low income people and their families. Some may have no health insurance or not enough, and therefore need this help.
If you have Medicaid, you should know that it pays for medicine given by mouth (orally) or by vein (intravenous). Each state has its own rules about who is eligible for Medicaid.
Other adviceDon't be embarrassed to tell your health care team if you're having trouble paying for your medicine. They may be able to prescribe other medicine that better fits your budget.
If you feel that you're overwhelmed, the stress may seem like too much to handle. You might try getting help with financial planning. Talk with the business office where you get treatment. There are many free consumer credit counseling agencies and groups. Talk with your oncology social worker about your choices.
You can also contact the NCI's Cancer Information Service (CIS) and ask for help. They have a database, National Organizations that Offer Cancer-Related Services that may help you. You can also access it online yourself. See Resources for ways to contact NCI.
Tips for saving money on pain medicine
If the cost of pain medicine is an issue for you, consider the following tips:
- Ask your doctor if there are generic brands of your medicine available. These usually cost less than brandname medicines.
- Ask your doctor for medicine samples before paying for a prescription. You can't get samples of opioids. But you can ask your doctor to write only part of the prescription. This way you can make sure that the medicine works for you before buying the rest of it. This will only help if you pay by the amount you buy. For some insurance plans, you pay the same amount for part of or the whole prescription. Find out what will work best for you.
- Ask about drug companies that have special programs to give free drugs to patients in financial need. Your doctor should know about these programs.
- Remember that pills may cost less than other forms of medicine.
- Use a bulk-order mail pharmacy. But first make sure that the medicine works for you. Also, be aware that you can't order opioids in bulk or through the mail. Ask your oncology social worker or pharmacist about bulk-order mail pharmacies.
- Contact NeedyMeds.
They are a nonprofit organization that helps people who cannot afford medicine or health care costs. Go to www.needymeds.com, or ask someone to do it for you.