Success Story: Everybody Needs a Little Time Away

Success Story: Everybody Needs a Little Time Away
October 30, 2020 Lisa Winter
pharmaceutical assistance program

Tracey just needed a break.

Lately, she felt like she was constantly on edge. She suffered from lupus, and was on new medications to help her manage her symptoms. The global pandemic put even more stress on her as someone who was at higher risk for catching COVID-19.

She and her husband decided to take a much-needed camping trip. She felt time outdoors would help her clear her head and feel better.

Now, Tracey needed to get her medications to take with her on the trip. But this filled her with worry. One was very expensive, and the other had not yet come in through mail order. She needed them desperately to manage her lupus.

Luckily, she had access to the CARE Program through Meritain Health® Pharmacy Solutions as part of her health care benefits. CARE is a special program that helps lower prescription costs for members whenever possible. A CARE specialist was already hard at work reviewing Tracey’s prescription coverage.

The specialist found a copay assistance program for the high-cost drug, offered by the manufacturer. It would save Tracey more than $1,500 per year, with a $0 copay. She contacted Tracey to get her enrolled.

While on the phone with Tracey, she learned of the mail order medication which had not yet arrived. Working quickly, the specialist was able to get a small supply of the second medication through Tracey’s local pharmacy. This way, even if her mail order didn’t arrive in time, she’d have medication to take with her on vacation.

Tracey was so relieved! She would be able to leave the stress of her day-to-day life behind for a bit, relax on vacation, and re-focus. And now, she’d have the medication she needed to maintain her quality of life.

She was very happy to have access to the CARE Program to continue her important treatment. She’d be able to keep managing her lupus, and get every benefit from her time away.


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 in any new or future case(s), as the result of each case depends upon many factors, including the facts of each case. 

Case savings include managed savings and negotiated savings and follow guidelines prescribed by the Case Management Society of America (CMSA). Managed savings reflect avoidance of potential charges that are realized through the intervention/actions of the case manager. Negotiated savings reflect savings off actual charges that are negotiated by the case manager with an individual provider.

This material is for information only and is not an offer or invitation to contract. Health benefits and health insurance plans contain exclusions and limitations; see your plan documents for complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary and are subject to change.