After experiencing pain and swelling in his back last year, Edward received some distressing news. He was diagnosed with a rare, chronic condition of the spine. Eventually, without treatment, his condition could worsen—and even start to affect how well he could walk.
To alleviate his symptoms, Edward’s doctor started him on medication right away. Treatments would involve a series of injections taken regularly. With the right care, he hoped to slow his condition from advancing.
Shortly after beginning treatment, Edward saw huge improvements to how he was feeling! Much of the pain and inflammation he’d felt before had gone away. Even better, he could walk and move around with ease. He even considered getting back to activities he enjoyed, like doing yoga and riding his bike along the beachfront.
Putting member health first
Not long ago, Edward started a new job. Until now, his medication—considered specialty—had been covered through his employer’s health plan. But, under his new plan, prescriptions like his would no longer be covered.
Edward wasn’t sure what to do. His treatments had been going so well. But, without help, he knew he couldn’t afford the high cost of his prescriptions.
Thankfully, Edward’s new benefits were through Meritain Health® and included access to the CARE Program.
Getting much-needed medication for less
Sometimes, participants can obtain access to prescriptions not covered under their health plan by applying to a patient assistant program (PAP) instead. By going through these manufacturer-sponsored programs, out-of-pocket costs are often lowered significantly. However, the process can be confusing to get started.
A CARE specialist, knowing how life-changing this medication had been for him, immediately stepped in with the support he needed. Edward’s specialist was able to enroll him in the program and handle all the necessary paperwork—making this option feel simple!
Once approved, Edward would gain funds to assist him for a whole year. So, to stay on his medication, he would only pay $25 out-of-pocket monthly, or just $300 a year.
Considering the full cost of the medication was $107,390—Edward was overcome with relief!
He can’t thank his CARE team enough for their caring support and expert know-how. And now, Edward can focus on his new job, his health and his path to recovery!
This story is based on an actual member experience. Names and information have been changed to protect the member’s privacy.
This communication is intended for informational, promotional purposes only. The reference to previous outcomes made as a part of this communication does not guarantee success or similar outcomes in any new or future cases, as the result of each case depends upon many factors, including but not limited to the facts of each case. Any actual savings will vary based upon numerous factors, and neither Meritain nor its affiliates guarantees any level of savings.
