The High Cost of Targeted Medicine

New drugs are pricey. But you may be able to get discounts and coverage for your prescriptions. Here's what you should know about the cost of targeted medicine.

When Jacqueline Herships went to her local pharmacy to pick up her one-week supply of ATRA, an oral vitamin-A-based compound used to treat leukemia, she experienced sticker shock. The $5,000 price for her prescription was more than she — or most people — could pay.

Herships, who works as a public relations specialist, felt overwhelmed. She knew she needed the drugs to fight her cancer. She also knew that paying $5,000 every week was not going to happen. 

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Self-employed and living in South Orange, N.J., Herships reached out to Edgar Brisbon, who describes himself as a mercenary for seniors. Brisbon, a certified senior advisor, runs Silver Lining Advantage, where he consults and helps people navigate the rough terrains of health insurance and healthcare administration.

Brisbon was able to knock the $5,000 price down to $9. He looked at her finances and saw that Herships qualified for the Pharmaceutical Assistance to the Aged and Disabled  program in her state. The program assists low-income individuals residing in New Jersey with the costs of their prescription coverage.

According to Brisbon, many states have similar programs that help people in specific income brackets cover the costs of targeted medicines. He suggests starting with the Patient Advocate Foundation, a national 501 (c)(3) non-profit organization that provides assistance with health insurance, job retention, and debt crisis matters related to your specific diagnosis of life-threatening or debilitating diseases.

Herships recommends hiring a patient advocate. Trying to pay for prescription medicines that keep you well and fight disease can be overwhelming.

“Some days the drugs make me feel exhausted or ill,” she said. “Having someone who can focus clearly when I cannot, due to the meds or being on chemo, is a huge help. A patient advocate works on your behalf, and in my case has identified ways to make treatments affordable.”

Her doctors designed treatment just for her. The approach is called precision or personalized medicine. Each person’s cancer has a unique pattern of biomarkers, genes, and other substances that may reveal vulnerabilities and prognosis. For years, most people with the same diagnosis have received similar treatments. With precision medicine, according to the National Cancer Institute, treatments are increasingly tailored to treat biomarkers. 

But personalized treatments are expensive. Many new oncology drugs, for example, are useful only for small groups of patients with a particular genetic profile and have stratospheric prices so pharmaceutical companies can profit and recoup their research costs.  

State legislatures have begun taking action to streamline insurance coverage.  Texas, Arkansas, Connecticut, Kentucky, Mississippi, Pennsylvania, and New York have all considered or passed laws to free doctors from the burdens of getting advance approval from insurers.

The U.S. House of Representatives passed a law to make it easier to get prior authorization under Medicare Advantage plans, the private insurance program within Medicare.

Such changes could hasten insurance coverage for innovative personalized care, which may make a difference in serious illness.  

If you’re faced with an expensive disease, you may have options. Drug manufacturers sometimes have patient assistance and discount programs and even foundations to help you. Check the websites or call the manufacturers of the drugs you need and talk to pharmacists or patient advocates at hospitals.

If you can join a clinical trial, your treatment generally will not cost anything.

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