- Meet Consumers/Patients
|Newsletters: Thinking Outside the Can|
Thinking Outside the CanAn Oley member, Heidi has written several “Outside the Can” articles for MitoAction. We hope to share more of these in upcoming issues of the LifelineLetter.
Medicare does not cover supplemental enteral nutrition if taken by mouth, even if the formula is medically necessary and constitutes 100 percent of the individual’s oral intake. At this time, these same products are approved for Medicare coverage if administered through a permanently placed feeding tube, such as a PEG tube. Individuals who are privately insured sometimes have very high deductibles and copays; those who receive Medicaid may not yet be eligible to receive services. Enteral nutrition can be very expensive, and many disabled individuals simply cannot afford special formulas, which may cost several hundreds to thousands of dollars per month.
Prescription HopeMany pharmaceutical companies offer patient assistant programs (PAPs) that distribute medication to individuals who cannot afford to purchase it. However, if a patient is on twelve different medications that are dispensed by eight different drug plans, each with their own application, it is very easy for the patient to miss questions or make clerical errors, both of which can disqualify an applicant. Prescription Hope acts as a pharmaceutical service coordinator to provide low cost medication and medically necessary nutritional supplements/enteral feeds to individuals who are uninsured or underinsured.
The Prescription Hope program has no annual enrollment fee, and each month’s supply of medication or medically necessary nutritional supplement costs $35 per prescription, regardless of the wholesale cost of the medication or medical food. They provide support from your initial phone call or e-mail inquiry until the medication or formula arrives on your doorstep; the support continues as you renew your application, change to another type of formula or supplement, or no longer need/qualify for the support.
Eligibility requirements may change, but as of this writing (September 2016), the Prescription Hope website says you may be eligible for this program if you: earn $30,000 or less per year as a single person or $50,000 or less as a couple (average; some pharmaceutical company’s guidelines may be higher); do not participate in Medicaid; and are experiencing financial hardship. They also note that you may have a discount prescription drug card and still qualify.
Available Enteral Products
Prescription Hope has supported an extensive list of enteral formulas, oral nutritional supplements, and complete nutrition. At one time, these have included: Elecare, Jr.; Enlive; Ensure; Glucerna; Hi-Cal Drink; Jevity; Juven; PediaSure; Polycose; ProSure powder; Promote; and Vital Jr. Please see the website for a full list or call to inquire about specific prescriptions and formulas.
LifelineLetter, September/October 2013
updated August 30, 2016