[Lucy]

I am a Native American woman. I had my breast cancer operation at an Indian Health Service - IHS - hospital. When I got home, I took my prescription to the IHS pharmacy that is on my reservation. The pharmacist there told me that she did not carry the medicine that the doctor had prescribed. I cannot afford to buy this medicine at another pharmacy - and besides, there is not another pharmacy near to me anyway. It is not my way to make trouble, so I just went home. The next time I went to see the nurse practitioner in the clinic, she asked if I had any side effects from the medicine. I had to tell her that I had not been taking the medicine - that I could not get it at the IHS pharmacy. The nurse said that she had heard that this medicine is not on the list of IHS approved drugs - what they call "the formulary." She decided to check this out. She called some other nurses who work with Native Americans and the IHS - and she found out that this medicine is on the formulary, but not all of the IHS pharmacies keep this medicine in stock. The other nurses suggested that my nurse or doctor talk directly to the pharmacist. These nurses also said that it would help to send a copy of my treatment plan, and one or two articles from the medical journals that describe the treatment plan to the pharmacist. My nurse and doctor did these things - and there was no problem at all. My IHS pharmacy got my medicine in very soon after this, and they keep it in stock for me.

[Narrator]

Even though Lucy's story involves an Indian Health Service situation, many insurance plans and entitlement programs do not have all of the information needed to make good decisions about what medicines to keep in stock or which medicines should be available to people covered by these plans. Often, the solution to this problem is very simple - involving only a little effort on the part of the doctor or nurse who can easily provide the kind of evidence needed to encourage the insurance company or pharmacy to make the medicine available. Again, just telling the doctor, nurse, or social worker that there is a problem is the first step to solving it. Sometimes, a generic medicine that does have the same effect as a brand name medicine is a good way to cut down on the costs of prescribed medicines. Many drug companies also supply doctors' offices with samples of medicines that are prescribed often. It is up to the doctor or nurse to decide which patients are given the free samples. There are federal, state, and even institutional programs that can help people get needed prescription medicines. These programs have eligibility criteria - ways to decide which patients get this kind of help. The social worker or pharmacist can help with information about this kind of assistance.

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