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Life Health > Health Insurance > Medicare Planning

Patient who skipped mortgage regains $13,000-a-month drug

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(Bloomberg) — A Medicare patient who stopped taking a Pfizer Inc. drug because he couldn’t afford his co-payments has resumed treatment after getting a new grant.

Despite having insurance, William Piorun of Kintnersville, Pennsylvania, faced out-of-pocket bills of more than $1,000 a month for various medicines to keep a potentially life-shortening, pituitary-gland tumor in check, Bloomberg News reported last week. The self-employed auto-parts supplier said he made about $45,000 a year.

The combined costs of his medicines — including his co-payment and Medicare’s share — were more than $20,000 a month. That included more than $13,000 for Pfizer’s Somavert, his single most expensive medicine.

In September, when $8,000 in charitable aid he received early in 2014 was running out, Piorun, 65, said he was forced to choose between paying his mortgage and taking Somavert. He skipped his mortgage in October and had only taken the medicine once since last summer — until last night.

See also: Plans in showdown against high-cost drugs.

After the Bloomberg article ran, the Patient Access Network Foundation called the Piorun family and said it would provide a new grant immediately, said William Piorun’s wife Robin. The foundation was also the source of the earlier aid.

In another call, a program manager at Pfizer assured the family that William would continue to receive the drug, Robin Piorun said. The new Somavert arrived yesterday.

Difficulty, persistence

“I am ecstatic,” William Piorun said. “It is a difficult situation for most people.”

After making a few unsuccessful calls for assistance, he would have given up if his wife hadn’t kept making calls for him, he said.

Pfizer said its prescription assistance programs provide the company’s drugs for free or reduced cost to eligible patients.“We are pleased our program helped the patient to continue on his medication,” the company said in a statement.

More than 300,000 Americans are now taking combinations of prescription drugs that cost $50,000 or more a year, based on Medicare data and estimates by Milliman Inc., a Seattle-based actuarial firm.

Prices like that have prompted insurers to shift a bigger portion of the costs directly to consumers. One in every six employer-based plans makes patients pay a percentage share, typically about 20 percent, of the bill for high-cost specialty drugs used to treat serious conditions, according to a survey by the Pharmacy Benefit Management Institute. Meanwhile, the specialty drugs have made the cost-sharing provisions in Medicare more expensive for the elderly.

New policy

As a result of Piorun’s case, the Patient Access Network Foundation altered its policy to let patients with acromegaly, Piorun’s tumor-related condition, get additional charitable grants if their initial funding runs out before the end of a year, said Daniel Klein, chief executive officer of the Washington-based non-profit.

Acromegaly results in excess hormones that cause abnormal growth of bone and other tissues. It can lead to premature death without medicines to keep the hormones under control.

Because acromegaly is rare, the foundation wasn’t aware until Bloomberg’s reporting that one grant might not be enough to cover a patient’s out-of-pocket expenses for a year in some cases, Klein said


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