How the Upstate pharmacy saved him $20,537.14
He went through a series of imaging tests, looking for an explanation for the pains in his stomach.
After all the scans were complete, doctors delivered the news to Reginald Sanford of Syracuse. He had cancer in his liver and also outside of his liver. Surgery would not work, but medication might slow the growth and spread of the cancer inside his liver.
They wanted to prescribe Nexavar, a drug with a price tag of more than $20,000 per month.
“It totally blew my mind. I told them there‘s no way I could come up with that. I ain‘t got that kind of money. I‘m retired. I‘ve only got $1,000 a month. How am I going to come up with that?”
Sanford says one of his doctors consulted with someone from the Upstate Outpatient Pharmacy.
Two days later, he got a phone call from a pharmacist. "Mr. Sanford,” he recalls the voice saying, “I‘ve got some good news for you.
“First of all, you don‘t have to pay a penny for your Nexavar. And the other good news is, we‘re going to get it out in the mail to you.”
Medication assistance coordinator Heidi King explains that after Sanford‘s Medicare coverage and personal health insurance coverage paid their portions, the remaining cost was going to be $970 for a one-month supply. She was able to enroll Sanford in an income-based New York state program called EPIC – for Elderly Pharmaceutical Insurance Coverage – which would pay $950. Then she located an endowment fund that would chip in $20.
King says “a lot of patients need financial help, especially with these types of medications.” Together with a colleague, her job is to help locate funding sources, particularly for patients whose prescription coverage leaves them with a huge copay.
Depending on each patient‘s situation, she may find money through a foundation, a drug manufacturer or a government program. “The majority of the time, we‘re able to get it down to a price that they can manage,” King says.
Pharmacist Eric Balotin, associate director of pharmacy enterprise, says, “We are always looking for ways to reduce copays and out-of-pocket expenses, whether it is $1,000 or $5. Our goal is to make the medications affordable to all our patients.”
Sanford believes he is doing well and that the cancer inside his liver under control. He realizes the day will come when the cancer outside of his liver will cause problems for him. Until then, Sanford dutifully takes two Nexavar pills in the morning and two at night.
Anyone can use the Upstate Outpatient Pharmacy
You do not have to be a patient at Upstate. The pharmacy is between the Upstate University Hospital lobby and the Upstate Cancer Center and can be reached at 315-464-3784. It‘s open 8 a.m. to 6 p.m. weekdays and 9 a.m. to 2 p.m. weekends and is closed on major holidays.
This article appears in the winter 2019 issue of Upstate Health magazine.