The program, called MedAssist, was developed to help people who fall through the cracks and don't receive assistance from other programs to cover their high out-of-pocket costs for drugs that, if used consistently, can prevent hospitalizations and even death.
The out-of-pocket cost of some medications for these medications can be in the hundreds of dollars. A one-month supply of insulin 20 years ago, for example, cost about $21; today, it's $275, county Supervisor Joe Simitian, who spearheaded the effort, said.
The cost for one asthma inhaler has jumped more than 50% in the past five years, from $316 to $496, Simitian said. A package of two EpiPen injectors costs $650, and the generic version of the drug costs $300, according to a January 2020 Board of Supervisors staff report.
Even with existing insurance, the cost still can be too high for some patients. One resident told Simitian that her co-pay through Covered California for a one-month supply of insulin was $55, but she didn't have the money after losing her job during the pandemic.
A 2019 study in the Journal of the American Medical Association found that as many as 1 in 4 people with diabetes were cutting back on their insulin or skipped doses to save money, Simitian said.
Going without insulin over the long term can cause blindness, heart disease, lower leg amputations or death.
"By helping to pay for prescriptions, MedAssist helps individuals who have diabetes, asthma, or severe allergies stay on their medications. Keeping people on their medications improves their health and the community's overall health outcomes," Nari Singh, director of pharmacy services at Santa Clara Valley Medical Center, said.
Program grants range from $39 to $350 monthly with an average grant of $141.45.
"That means the average program participant saves in excess of $1,500 a year," Simitian said.
The cost to the county would also be significantly lower by preventing severe illness through these medical preventative measures, the county said.
MedAssist is available to Santa Clara County residents ages 18 and older who use retail pharmacies like CVS and Walgreens, including individuals and families with middle incomes. Eligible residents who participate in the MedAssist program will receive a check each month to help them pay for their prescription costs, including those filled at retail pharmacies, according to the county.
A resident's annual income also must be below a certain threshold for their household size to qualify for reimbursement, according to the county. For a household of four, a program participant must make less than $251,000 to qualify.
"A lot of folks are part of that 'missing middle.' They make a little too much to qualify for Medi-Cal or other programs like it, but not enough to afford high-quality, market-rate health insurance," Simitian said. "These are essential medications — lifesavers, truly — but the cost is out of reach for middle-class families."
According to county health data, nearly 400,000 residents have asthma, diabetes or use an EpiPen to combat severe allergic reactions. Of those, 118,900 adults have diabetes mellitus, 257,000 adults and children have asthma and 21,600 individuals are prescribed epinephrine auto-injectors, which prevent severe, life-threatening allergic reactions.
The county initially started a MedAssist pilot program in 2020 and turned it into a permanent program during the 2021-2022 fiscal year.
MedAssist program applicants must be adults living in Santa Clara County, have a valid prescription for the relevant medications and meet the program's income requirements.
"Our goal is simple: keep people alive and well, affordably," Simitian said. "MedAssist can help make that happen."
Application information for the MedAssist program and income thresholds for various household sizes can be found at www.scvmc.org.
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