Lara Tushla, LCSW
Healthcare is always changing and transplant is no different. One change that has been affecting transplant patients is the availability of generic versions of two anti-rejection medications - CellCept® and Prograf®.
The question about whether generic medications are an option for you is a conversation you need to have with your Transplant Team.
We have been hearing some things from our patients:
- They don't make the brand name medicine anymore.
- Medicare won't cover the brand name version.
- Your copay for the brand name medicine is now several hundred dollars per month.
- CellCept and Prograf are still being made. As I understand it, it is often a reimbursement issue for the pharmacy which makes it financially difficult for pharmacies to dispense the brand name version.
- The Medicare question is one of billing rates. Medicare has one code whether you take brand CellCept or generic mycophenolate mofetil. The same goes with Prograf. Medicare reimburses the pharmacy the same amount whether you get the brand or generic version of these medicines. In essence, the pharmacy's reimbursement will seem less for a brand medication, especially since it costs them more to purchase, carry and dispense it. Therefore, the reimbursement for the brand name medicines isn't as good for the pharmacy and they may lose money when dispensing the brand name drug.
- One of the hardest parts of all of this is the financial impact and stress it can have on transplant recipients. When you hear that there are big copays, you have a few options. The first step is to double check your prescription coverage. You can call your insurance company to check the copays for both the brand and generic versions of the medicine – ask for both 30 and 90 day supplies. We have been finding that some insurance companies are not only changing the brand level copay, but in addition, charging the patient the difference between the cost of the brand and generic medication, known as an “ancillary fee” or “penalty fee.” This can come to several hundred dollars for monthly copay.
Another option is to contact assistance programs for these medicines. They can help investigate your copays and identify options, including some of the resources below:
- Copay assistance cards: The makers of CellCept, Prograf, Myfortic, and Neoral have cards that can aid in covering all or portions of your copay. (NOTE: Myfortic is not available in a generic version.)
- However, these cards cannot be used for Medicare (Part B or D), Medicaid, or TriCare copays.
- Your transplant team has access to these cards and can provide them to you. Values of the card vary per medication and may or may not cover your entire copay expense.
- Foundation: The Healthwell Foundation has grants available that can sometimes help with copays on anti-rejection medicines: 800-675-8416 or www.healthwellfoundation.org
- Approval is based on household income and availability of funds.
- Patient Assistance Programs: The companies that make the anti-rejection medicines have programs available to offer free medicine depending on your income and insurance situation. Below are websites and contact information:
When you pick up your medicines from a pharmacy, check to make sure your medicines are correct. If you don't recognize something, ask the pharmacist. The generic pills may look different from the brand. Before switching to a generic version of these medicines (mycophenolate mofetil or tacrolimus), talk to your transplant team. They will probably have you do more frequent blood tests to make sure that your levels of the medicines are stable. Since there are different generic versions of each of these medicines available, it is recommended to talk to the pharmacy to make sure that they can consistently give you the same version of the medicine every month. Not all pharmacies can guarantee this.
Switching to generic medicines has been done safely with transplant patients, if the team is aware of the change and the drug levels stay consistent.
Above all, when you have questions about your anti-rejection medicines, coverage, need help with copays, and brand-vs-generic options contact your transplant team and work with them to preserve your health and your transplanted organ.
Lara Tushla, LCSW, NSW-C, is a kidney transplant Social Worker at Rush University Medical Center in Chicago, Illinois.