Santa Clara County resident Henry has been diabetic for nearly his entire adult life, and he started taking insulin about three years ago to treat his illness. But between him and his wife, Mary, who together battle a number of chronic illnesses, the medical expenses started to pile up.
The couple heard about MedAssist, a Santa Clara County program that helps county residents with the cost of a few specific types of medications: insulin, asthma inhalers and epinephrine auto-injectors, also known by the brand name EpiPens, which deliver life-saving medication in the event of a severe allergic reaction.
According to county data, 118,900 adults have diabetes mellitus in Santa Clara County, 257,000 adults and children have asthma and 21,600 individuals are prescribed epinephrine auto-injectors.
"So we thought, well, let's see if we qualify," said Mary. This news organization agreed to identify her and her husband by their middle names to protect their privacy. "We were, I think, among the early enrollees, so the process was very, very quick."
Henry was accepted into the inaugural 2021-22 program year, and has just re-enrolled for 2022-23, for which the county is currently accepting applications. Patients can apply until April 30, while funding lasts. Once funding is exhausted, the county will open a waitlist.
Qualification and the amount of financial assistance for the program is based on the patient's income level and the health care expenditures, according to Joy Alexiou, Santa Clara Valley Health and Hospital System communications officer.
"People with high out-of-pocket expenditures receive monthly grants that inversely correlate to their income levels," Alexiou said, meaning that the lower someone's income is, the higher the grant.
Mary said the enrollment process was simple: The couple had to upload a tax return, proof of purchase of Henry's insulin and proof of residency in the county.
"That's really all there was," Mary said. "They got back to us within 24 hours. We just enrolled for the second year, and the process was slower, but I think that there are probably many more people now queued up in front of their door. Once we were approved, the process was quick."
Each month, Mary said, she and Henry submit proof of purchase of his insulin to the program.
"His use of insulin is variable, so we have to give a little bit of thought to trying to make sure that we make a purchase every month," Mary said. "Or, alternatively, there are times where the pharmacy dispensed a lot more to us than we were expecting. It turns out we can upload that, and if when we uploaded it we marked it as a three-month supply, then they would credit the three months."
The rising cost of medications in the United States is a major barrier to access, causing some people to take their medications less frequently than prescribed, Alexiou said. Insufficient treatment of diabetes can accelerate vision loss, end-stage renal disease and death. To help county residents with the cost of these vital medications, Supervisor Joe Simitian proposed the program, which the county Board of Supervisors approved and then soft-launched in October 2021.
"The program is specifically designed to support the 'missing middle' population who reside in Santa Clara County," Alexiou said. "These are the individuals who may be enrolled in a health insurance program, however, (they) are forced to pay high out-of-pocket costs for life-saving medications such as insulin, asthma inhalers and/or epinephrine auto-injectors."
For Mary and Henry, being MedAssist recipients means more peace of mind and one less medical expense to fret over.
"It's just lovely to have this benefit, given we have such a huge amount of out-of-pocket medical expenses," Mary said. "This is just a nice thing to have. It's very easy, and they are absolutely lovely over there. … You get the sense that they are delighted to be helping you."
To apply for MedAssist, recipients must be 18 years or older, reside in Santa Clara County, have a valid prescription for an asthma inhaler, insulin or epinephrine auto-injector and meet household out-of-pocket health care spending and annual gross household income requirements. More information and a link to apply can be found at scvmc.org.