MedAssist Program Helps the 'Missing Middle' with Prescription Expenses
No matter where you get your care, County program offers reimbursement assistance for diabetes, asthma, allergy meds
SANTA CLARA COUNTY, Calif. – For thousands of Santa Clara County residents, getting needed and potentially life-saving medications can involve an uneasy triage: How important are those meds, paid for out of pocket? Where do they sit compared to other necessities such as putting food on the table, or paying rent, childcare costs and insurance?
This population is the “missing middle” – individuals who may be enrolled in a health insurance program but are forced to pay high copay costs for life-saving medications: Drugs for diabetes, asthma inhalers, and epinephrine auto-injectors.
“Life-saving drugs cost too much,” said County of Santa Clara Supervisor Joe Simitian, who serves as chair of the Health and Hospital Committee. “Unfortunately, too many folks don’t qualify for available subsidies and end up paying an arm and a leg for their medication.”
Enter the County’s MedAssist Program, which started earlier this year and was recently expanded to include all diabetes medicines, beyond just insulin.
Qualified patients receive grants to offset their expenses for high-priced medicines, and the bar to qualify is set to include those who may be ineligible for low income assistance; for example, a family of four can qualify with a gross household income of $263,000.
“I never qualified before,” said Carol Tapella, 77, a lifelong San José resident who chooses her Medicare plans very carefully each year but still did not have coverage for all her medications, including for asthma and diabetes. “My husband and I were educators and that throws us into a bracket where we can’t qualify. But I went ahead and filled out the form, I got a call from someone with the program who walked me through it. They ended up approving the meds – it meant so much to me!”
In Santa Clara County, there are an estimated 118,900 residents diagnosed with diabetes, 257,000 with an asthma diagnosis and 21,600 with prescribed epinephrine auto-injectors.
County healthcare officials stressed that the program is not just for those enrolled in the Santa Clara Valley Healthcare plan. They can get their medicines through any other health provider, and buy them at any pharmacy – no matter where you get your care, the County is here to help.
“MedAssist may now help any individual with diabetes stay on their medications,” said Nari Singh, Director of Pharmacy Services for Santa Clara Valley Medical Center, after the program was expanded to cover all diabetes prescriptions. “With financial support, they can get the medications they need and improve. People who live in Santa Clara County should take advantage of the MedAssist program.”
Supervisor Simitian said the program offers relief to the high cost of co-pays.
“I encourage people to apply,” he said. “Our goal here is to keep you well and cut your costs.”
Carol Tapella said the process to get the reimbursement was simple and encouraged others to look into it, and added she had an exceptional experience with County staff she reached on the information line.
“I couldn’t believe it, the people were wonderful, they really made it all very easy,” she said. “If people knew the support I got from them I’m sure they would apply to the program, too.”
By Eric Kurhi, Office of Communications and Public Affairs
This program provides eligible residents with a monthly grant to assist in paying for their life-saving medications. The eligibility criteria for this program are:
• 18 years of age or older
• Reside in Santa Clara County
• Have a valid prescription for an asthma inhaler, diabetes medications, or epinephrine auto-injector
• Meet household out-of-pocket healthcare spending and annual gross household income requirements
The application process is quick and accessible to everyone. Log into the website at www.scvmc.org/medassist to apply online, or download the paper application and submit it to any SCVMC pharmacy locations. Staff will help guide a resident through the process to ensure it is seamless. Once accepted, participants receive a monthly check to assist with payment for these medications. Call 408-970-2001 for more information.