A local clinic might have a line on affordable meds

Your mileage may vary, but here’s a roadmap.

Hey there!

To wrap up our series on workarounds for high drug prices, The Prescription Drug Playbook, we’re looking at a strategy one Arm and a Leg listener suggested: Connecting with a community health center that offers sliding-scale fees — and may offer meds at super-discounted prices.

This is very much a “Your Mileage May Vary” situation, in more ways than one.

Most importantly: In general, only folks with lower incomes can access these discounts. There are tons of other caveats too — and a ton of variables that could affect your situation.

Here’s our guide to figuring out if you — or someone you know — could actually benefit.

How this works, when it works

Across the country, more than 1,400 federally-funded community health centers provide health care to anyone who walks in: with or without insurance, even if they can’t pay.

These clinics can buy many drugs at steep discounts.

How steep? As Arm and a Leg listener Cristy Gupton told us, these clinics can get the notoriously-expensive drug Humira — which can cost thousands of dollars — for a penny.

That got our attention, and it checked out. BUT… there are a lot of buts.

First: As experts told us, Humira’s an unusual case. One study found that on average, the discounts average about 50 percent.

Second: Even if the health center gets your drug for a penny, that doesn’t mean you could get it for a penny. Each health center sets its own price for what any individual patient actually pays for a given drug.

But you could *maybe* get it super cheap. And in cases where the center pays a lot more than a penny, they might get it to you for less than they paid.

We’re throwing a lot of maybes at you. Let’s nerd out a little about the rules, to get a little clearer.

The rules: income requirements, and prices

First, federal rules set an income limit to qualify for super-discounted care (and maybe meds) from these clinics: two times the federal poverty level. As an example, that’s about $64,000 for a family of four.

So step one: check your household income using the calculator here.

Second, federal rules say these centers have to make medicine “affordable” for people who meet that income requirement — but the rules don’t say exactly what affordable means.

So what price you pay will depend on the center’s own policies. So…

Step two is: Find a health center near you, and call to find out what their deal is. Here’s a handy tool to find that center.

But before you call, strap in for more details to help you scope this out.

You’ll need to see a provider at the center

Federal rules say health centers can only offer discounted meds to established patients.

Which, by the way, you might actually want to become: These centers offer lots of affordable health care services at a sliding scale. An early Arm and a Leg story profiled one that achieved impressive patient-care stats, with a ton of heart.

But if you don’t want to totally overhaul your care routine, you may have some wiggle room.

Cristy Gupton, the Arm and a Leg listener who pointed us to these clinics as an option — and has experience sending folks in this direction — tells us that in some cases, a single telehealth visit can be enough to become an established patient.

So, again: Your mileage will vary, and you’ll have to do some investigating. Some phone calls. Speaking of mileage…

Your mileage may *literally* vary

And your closest option to actually get discounted meds might be far away. As experts told us, some centers — especially in spread-out and rural areas — cover huge swaths, even hundreds of square miles.

And although a given center may have multiple locations, discounted meds may only be offered at certain locations — and if you need multiple meds, they may not all be available at the same location.

We heard about what sounds like an absolute worst-case scenario from Colleen Meiman, a policy advisor for community health centers: A part of Arizona where, to get a specific drug, some patients might have to drive 10 hours each way. Again, that’s a very specific case.

Time to start investigating how this might actually work for you.

So, here’s your roadmap

Starting with a quick review, plus some helpful details:

First, check your household income with the calculator here: Are you below 200% of the federal poverty level? Keep going.

No? This may be worth pursuing anyway — different centers can sometimes extend sliding-scale help to folks above that line, expert Colleen Meiman told us.

Second, see what centers might be near you with this search tool from the feds.

That tool is handy, but heads up: search results for your zip code may include things like school-based clinics and clinics in temporary housing shelters. You’ll want to look for things labeled “health center.”

Third, if there’s a center (or more than one) near you — or near enough — call them for some specifics.

• Can you actually get discounted services there?

• How do they help qualified patients get affordable meds? How does the program work? How does it work for the meds you actually need?

• In case it helps: the federal program that allows centers to get these drug discounts is called 340B. You might use that term when you’re asking about discounted meds.¹

Finding out could be a little bit of a project. There are thousands of centers, serving millions of patients, and the “intake” process is gonna be different at each one.

But we’ve heard from people who have used these discounts, and the health center we profiled on the podcast definitely used this program to help people get affordable meds.

As always, if you give this a try, or if you’ve had experience with it, we’d love to hear from you.

Meanwhile, this wraps up our Prescription Drug Playbook project for now.

We’ve collected the whole series — four newsletters, two podcast episodes, and a delightful bonus — at armandalegshow.com/drugs.

Thanks to the dozens of readers and listeners who chimed in with stories and tips, and to the experts who helped us make sure we got it all right.

That’s all from us for now — have a great long weekend!

— Emily, Dan, and Claire

1. 340B is a HUGELY complicated story of its own, and it’s controversial. Our pals at the podcast Tradeoffs have covered some of the outlines.