IOWA CITY — When Wendy Ostrem graduated from pharmacy school at the University of Iowa in 1986, pharmacies were in a different world.
“When I graduated, people didn’t even have prescription insurance,” said Ostrem, a pharmacist financial counselor for the UI Health Care Medication Assistance Center. “If you had to pay $50 for a prescription at a pharmacy, that was really expensive.”
Today, that $50 would be considered a discount for many patients in Iowa. Last year, for example, over 50,000 Iowans on Medicare paid an average of $650 each year for blood thinners like Eliquis and Xarelto — some of the most commonly used drugs. In 2022, Iowa had the fifth-highest average annual out-of-pocket cost for Eliquis, Xarelto and Jardiance, a diabetes treatment.
With more sophisticated and more expensive drugs advancing every year, the annual sum Ostrem’s work saves patients continues to climb — 38 years after she started. In the last fiscal year alone, the UIHC Medication Assistance Center saved patients over $69 million. Ten years ago, that number was nearly 10 times smaller: $7.9 million.
Any patient at the UI Hospitals and Clinics can be referred to the Medication Assistance Center for help if they have financial concerns.
“Now, we have wonderful drugs that treat things that were never treatable before,” she said. “But they come at a cost.”
How she got into it
The Medication Assistance Center came with the advent of electronic medical billing, as many institutions like the UI entered the computer age. As prescription costs started to grow, insurance companies started allowing pharmacies to electronically bill prescriptions to collect from patients at the point of sale.
In one sense, the reason for some increased costs is a good thing, Ostrem says — drug manufacturers are investing in new avenues of research and development that can deliver life-changing treatments.
“There’s a lot of things in our health care system that could be fixed. Our job is to work within the confines of the system the way it is now, to help patients today.”
Over the years, prescription insurance became as prevalent as health insurance covering the hospital and clinic visits where they were prescribed.
“When we first started, we had a lot of patients with no insurance. Not every one had prescription insurance, it was a newer thing,” Ostrem said. “Employers didn’t always offer it.”
One impetus for the center was the constant need, as identified by social workers at the UI Hospitals and Clinics, for more affordable prescriptions. If patients couldn’t find cost savings by going from a tablet to a capsule, for example earlier in her career, Ostrem could hand cases over to social workers who would try to find alternatives to help patients avoid rationing medications.
Tools and techniques
In the early 2000s, one of the biggest tools in their toolbox was effective only for the uninsured — programs for free drugs to those who qualify, from the pharmaceutical companies that make them. Ostrem could also use her pharmaceutical knowledge to help doctors find less expensive alternatives.
But over time, even some of those with insurance have struggled with the cost.
When the Affordable Care Act was passed in 2010, Ostrem’s team was able to shift to help the underinsured, too. Today, her center also helps patients afford certain outpatient treatments like injections and infusions.
“To me, an underinsured patient is anyone who can’t afford their medication,” said Ostrem.
Today, as the program continues to mature in an evolving landscape for prescription drugs, there are more resources at its disposal. For those on most insurance, copay cards for unaffordable drugs can be obtained more easily online. Copay assistance foundations, another newer tool, are geared toward patients on Medicaid or with specific diagnoses.
The center also collaborates with SafeNetRx, a nonprofit drug repository in Grimes, that distributes donated medications as a short-term stopgap for Iowans.
“There’s a lot of things in our health care system that could be fixed,” said Ostrem, 61. “Our job is to work within the confines of the system the way it is now, to help patients today.”
But despite the stress of a complicated system, she said the satisfaction of assisting patients who feel like they’re in hopeless situations is unparalleled — simply by helping them get the treatment they need.
“People are moved to tears more than occasionally. I feel like the population we have in Iowa are good, hardworking folks who are doing what they can to get by,” she said. “I grew up in Iowa, I feel that deep in my bones. It makes me happy to help.”
Comments: Features reporter Elijah Decious can be reached at (319) 398-8340 or elijah.decious@thegazette.com.
