Providence Medication Assistance Program Saves Patients Millions

Almost on a daily basis John Hylton and Rick Carns are called angels, or the “answer to our prayers.”

“We get calls or cards regularly,” said Hylton, manager of the Providence Medication Assistance Program, or MAP. The duo works with patients who can’t afford or have been denied expensive drugs and finds programs to get them at no or low costs.

In 2019, they filled 1,286 prescriptions for oral medication and saved patients more than $3.5 million.

“We’re not ‘at the bedside’ caregivers, but I truly believe we save lives,” Hylton said. “We’ve been told that. I’ve had patients flat out say, ‘You got me that drug and if it wasn’t for you I wouldn’t be alive today.’ ”

For patients without insurance, MAP goes directly to manufactures to find free drug programs. It helps patients with refills and medication on an ongoing basis after discharge. Other assistance comes when a needed medication is denied by insurance. The MAP team works as a patient advocate with the insurance company to make sure needed medications are covered.

$79,000 bill becomes $200

In 2013, Alan Teitzel was diagnosed with a rare autoimmune disease. He thought he was in remission until November of 2018 when it flared up. His lung capacity was compromised. After trying several drugs which either made the disease worse or just didn’t work, his only option was Rituxan and he was scheduled for seven infusions, at a cost of about $25,000 per treatment.

Alan works full time and is fully insured. His insurance covered the first three infusions, but then communicated that because he didn’t have cancer, the remainder of his treatments would not be covered.

“I tried every avenue possible. I talked with my union, state legislators – it seemed like every person on the planet – and the insurance company denied my appeal twice,” Teitzel said. He had a $79,106 bill and other procedures in front of him. In a last ditch effort, he reached out to Hylton and the MAP program.

“I remember he was telling me his story and was getting worked up and started breathing heavy,” Hylton said. “I just said ‘Alan, stop, I got this for you. Your doctor appealed this and said it was medically necessary. I can help.’”

Hylton enrolled him in the program and called him later to tell him he was able to get rid of $78,900 of that original bill. The out-of-pocket cost for the infusions would be around $200.

“It was like lifting a truck off my back,” Teitzel said. “I can’t say enough about those guys and that program. And now that I’m enrolled, if I need other assistance I can go back and I am still approved.”

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