WARSAW — The K21 Health Services Pavilion is home to a variety of non-profit organizations which provide health services for local residents. Unfortunately, many people in the community don’t realize these programs exist.
Warsaw resident Mildred Behnke is hoping to bring awareness about how these organizations can assist in meeting the needs of local residents by sharing her story.
Behnke has been diagnosed with pancreatitis. She was prescribed a medication for this and has been paying $45 a month for that medication. Earlier this month, Behnke stopped by the pharmacy to pick up her medication – and was told the cost was almost $600. Behnke discovered that she had fallen into the “donut hole.”
Most plans with Medicare prescription drug coverage have a coverage gap, referred to as a “donut hole.” This means that after a patient and their drug plan have spent a certain amount of money for covered drugs, the patient has to pay all costs out-of-pocket for their prescriptions up to a yearly limit.
“My head was whirling,” said Behnke. “I was reaching out trying to grab something because I was sure I was going to hit the floor. It didn’t make sense.”
Because she was unable to afford the prescription, Behnke left the pharmacy without her medication.
“I was dumbfounded. I went home and sat and cried and prayed,” Behnke said. “I got my checkbook out and was trying to figure out what to do. I thought maybe I could try to sell some of my belongings so that I could pay for the medication.”
Although her prescription dosage is six pills per day, Behnke began taking partial doses in an attempt to stretch the medication out.
“I thought taking a little would be better than none at all,” said Behnke.
Unsure where to turn for help, Behnke contacted Anita Carter, a nurse at Dr. Brian Reichenbach’s office. Carter agreed to look into the matter to see what could be done. Behnke then went to Kosciusko Community Senior Services in Warsaw.
“I was going in circles. I didn’t know what to do,” said Behnke.
“She was quite emotional,” said KCSS Executive Director David Neff. “I knew about the nonprofit organization Medication & Dental Assistance. I wasn’t sure they would be able to help her, but I thought it was worth a try.”
“She’s on a fixed income of approximately $1,400 a month. Just think about it. If $600 of that is going for one medication, how are you going to pay the bills? It’s impossible,” Neff stated. “Rent, food, clothes, gas – I mean, that’s nearly half of her monthly income – and she’s on other medications too.”
Neff took Behnke to meet with Melody Feaster, a patient advocate for Medication & Dental Assistance. Feaster found that Carter had already made contact with the pharmaceutical company. Feaster took steps to complete the application process and confirmed that Behnke was approved.
“It’s not unusual for someone to come in, such as Mildred, and she has insurance, but unfortunately her insurance didn’t cover the full price of her medicine,” said Feaster.
“It’s key is for these nonprofits to get together so that we know what each other is doing,” Neff stated. “I’m not an expert on what they do, but I knew enough to get Mildred connected with the right person.”
“We were there for approximately 45 minutes and by the time we left, Mildred had a $500 emergency relief voucher for this month’s medication and qualified for a program that will pay her prescription cost completely for the rest of the year,” said Neff.
“A lot of people don’t realize they’ve maxed out certain benefits,” said Angie Summers, director of Medication & Dental Assistance. “They don’t realize until they go to the pharmacy and find that their medication, which was once very manageable or even free, is now astronomical.”
“There’s no shame in asking for that help or in knowing what’s available,” said Glenn Hall, executive director of Kosciusko Home Care and Hospice. “Even if you don’t need that help today, you may need it tomorrow – or you may know someone else who needs help today.”
“Until I began working here, I had no idea that these organizations existed,” said Hall, “So I am passionate about getting the word out and letting people know there is help out there.”
“It’s the old adage of we don’t know what we don’t know,” said Hall. “Is there help out there? Where do I go for help? Many patients don’t realize that many of the pharmaceutical companies have an assistance program to help cover those very expensive medications.”
“We try to take that stigma out of it for people because sometimes it’s difficult for people to ask for help,” said Summers. According to Summers, the cash price for medication at pharmacies varies.
“A lot of people are used to paying copays, and their $10 copay is going to be the same at any pharmacy, but the cash price for the medicine can be drastically different from one pharmacy to the next,” said Summers. “We do a lot of research and price comparisons – it’s a teachable moment so the client can see that once they’ve used up our vouchers, they can purchase this medication for $24 at this other pharmacy with this coupon. We are not only helping them financially, but when they leave our office, if they’ve exhausted all of the services they can get with our program, they still have lower out of pocket costs going forward.” Goodrx.com is one site available for comparing pharmacy prices and printing free coupons.
“Everybody needs some sort of help sometime,” Summers added. “It’s a true joy for us to be able to watch somebody walk out of here a lot lighter than when they walked in because we’ve helped alleviate some of that stress.”