Santa Clara County Families May Get Relief From Skyrocketing Prescription Drug Prices
SAN JOSE (KPIX) -- Relief from skyrocketing prescription drug prices may be on the way to qualifying families in the South Bay thanks to a new program called MedAssist.
The pilot program is aimed at the "missing middle", households with incomes that are too high to qualify for the county's safety net programs, but still pay hundreds of dollars out-of-pocket every month for medicine, even with health insurance.
Santa Clara County Supervisor Joe Simitian, who began laying the groundwork for the program before the onset of the pandemic, said there was no time to wait for drug price reform from Washington D.C. or Sacramento.
"The folks I represent can't wait. They got a problem right here, right now. And it costs a small fortune to make sure they stay well. We've waited a long time. We can't wait any longer. If that means that the local folks have to find local solutions, so be it," said Simitian.
MedAssist only serves patients who require regular doses of insulin, asthma inhalers, and epinephrine injection pens.
To qualify, applicants must be 18 years old, reside in Santa Clara County, show proof of out-of-pocket expenses, and have a valid prescription. The county is not requiring proof of income, for now, in order to remove barriers of entry. But program managers will be monitoring for fraud and may impose a proof of income requirement at a later date, if needed.
The county will approve submitted applications within 30 days. After payments are disbursed, recipients must continue to submit proof purchase of the medication.
The subsidy is dependent on the applicant's income. For example, a household with a $200,000 income and $8,500 in annual out-of-pocket prescription drug expenses would qualify for $282 per month.
"Even middle-class folks who make what we think of as a pretty good income have discovered that they need help covering the cost. And with MedAssist, they're going to get it," said Simitian.
Narinder Singh, Pharmacy Director at Valley Medical Center, said patients who forgo paying for prescription medication in order to cover other living expenses oftentimes have worsened outcomes, or wind up in the emergency room seeking treatment.
"And if we can reduce those unnecessary visits to the ER we are reducing the health care costs within our community," said Singh.
According to county estimates, about 400,000 patients require insulin, asthma medications, or epinephrine. And 100,000 of those patients would qualify for MedAssist.
Singh called it a "grave situation," and estimates that for every 1,000 people who sign up for MedAssist, about three lives would be saved.
"The analogy I always use is when the house is on fire you have to react and take care of the situation. We can always think about building better houses, building a better fire station, and building all the other things. But when your house is on fire, you have to take care of that immediate issue," said Singh.
Since the soft launch in 2021, about 100 people have signed up including Robert Donovan, who at one point paid $350 a month for Advair Diskus inhalers for his chronic asthma.
Donovan, who receives Social Security, said he was forced to sell many of his possessions and would often have to pick and choose between paying for essentials.
"Just basic everyday things. Gasoline, food, it's terrible. I would go through my Advair and decide some days, 'Do I just skip it and save, and then go through the day wheezing?'" said Donovan. "It is an absolute drain on us to survive each day."
Donovan applied, and was approved for a $105 monthly payment.
"That's a week's groceries. Anything like this is welcomed. I'm just very grateful that this program is available and encourage other people to use it too," said Donovan.
The pilot program's initial round of funding is $1 million. The supervisors will re-assess the program by summer, ahead of the start of the new fiscal year on July 1.
To apply, visit scvmc.org/medassist/apply, call 408-970-2001, or email medassist@hhs.sccgov.org