One Patient’s Struggle to Get Leflunomide—without Breaking the Bank
Roxie Greenway has been on leflunomide for 11 years. It’s been a crucial medication for her rheumatoid arthritis. When she tried the first-line treatment, methotrexate, she developed pneumonia-like “methotrexate lung.”
When she tried to get leflunomide refilled in June, her insurance company told her it was going to cost her $600 for the three-month supply, rather than the usual $30.
The generic, which she normally used, was out of supply, so she would have to get the brand-name drug—and pay for it.
“The brand is exorbitantly expensive, so it’s extremely difficult to get the prescription filled and not have to pay a $600 co-pay,” says Greenway, who lives in Austin, Texas.
Greenway says she has gotten used to haggling with the insurance company to get the co-pay reduced. “It usually takes three layers of approval,” she says. “Usually you have to go through several layers.”
Greenway ended up having to pay $80—still more than the usual $30 but much less than $600—and it took 25 days from the time she first tried to have the prescription refilled. She went without the drug for three or four days, but it takes about two weeks without it to start feeling any ill effects, she says.
Greenway’s physician, Dr. Fudman, says patients should not have to haggle with pharmacies and insurance companies if a generic is not available but the brand is. He says he notes “product selection permitted” on the prescription, but that often doesn’t work.
“When you sign the form ‘product selection permitted’ it should mean just that,” he says. “If it’s written as a generic name and all they have available is the brand then that’s what they should dispense. And insurance companies shouldn’t penalize patients for it as they do when patients want the brand drug instead of a generic version, if in fact there is no generic drug available.”
Kevin Schweers, a spokesman for the National Community Pharmacists Association, says there is no easy solution in a situation like Greenway’s.
“First, if a particular generic isn’t immediately available, a community pharmacist will work with their wholesaler and backup wholesaler(s) to get it in stock,” he said in e-mailed remarks. “If, after exhausting those options, it is still not obtainable, substituting a brand-name for a generic, as you describe, can be difficult. The bottom line is the patient’s insurance almost certainly would reject the claim.”
