Success Story: Major Savings on a Life-Sustaining Medication

Success Story: Major Savings on a Life-Sustaining Medication
March 15, 2021 Lisa Winter
CARE program high-cost specialty drug

Ryan‘s job keeps him very busy.

He works in a warehouse, and he’s on his feet most of the day. Although usually upbeat and full of energy, Ryan just hasn’t felt like himself lately. He’s been feeling really worn out. And he’s been noticing some pretty regular stomach pains, which have made him a little uneasy.

After weeks of feeling lousy—and with his stomach pains getting worse—Ryan finally decides a trip to the doctor is in order. After running some tests, his doctor diagnoses him with ulcerative colitis.

Ryan is nervous hearing this news, but relieved to know why he hadn’t been feeling well. To ease his stomach pain, and avoid serious complications that could develop, his doctor recommends a treatment using a brand-name specialty drug.

Ryan understands this medication can help him stay healthy and avoid devastating conditions—such as abdominal infections, bowel perforations, or even colon cancer. But the price tag of the recommended drug gives him that uneasy feeling again. It could run him (and his employer) somewhere in the neighborhood of $133,000 per year. Yikes.

Luckily, Ryan’s health care benefits are through Meritain Health®, and his plan includes the CARE Program for prescription support. Since Ryan’s medication claim exceeds $5,000, a CARE specialist is assigned to see if they can lessen the out-of-pocket price for both Ryan and his employer.

Working together with Ryan’s doctor, the specialist decides getting him enrolled in a patient assistance program (PAP) might help with the hefty cost of the brand-name drug treatment. To put the wheels in motion right away, the specialist takes care of filling out the necessary forms and getting all the benefit details to the PAP.

Good news comes really fast. Once the PAP reviews Ryan’s needs, they approve him to receive his medication—free of charge!

Ryan is so happy and grateful to have had a CARE specialist on his side. He can get back to just feeling better again. And with his Meritain Health benefits, he and his employer will save over $133,000 for a year of the medication.


This story is based on an actual member experience. Names and information have been changed to protect the member’s privacy.

This communication is intended for informational, promotional purposes only. The reference to previous outcomes made as a part of this communication does not guarantee success or similar outcomes in any new or future cases, as the result of each case depends upon many factors, including but not limited to the facts of each case. Any actual savings will vary based upon numerous factors, and neither Meritain Health nor its affiliates guarantees any level of savings.