The cost of immunosuppressive drugs is staggering. But did you know just how much the cost varies from one pharmacy to another? And insurance companies don't seem to apply "customary charge" guidelines to pharmacies as they do to hospitals and doctors. So it is up to you to be sure you are getting the best value for your money. Even if you think you don't have to worry about it because insurance is paying the bill, be careful. Many, if not most, health insurance policies now have a lifetime cap, and you don't ever want to reach that if you can avoid it.

We encourage you to be an informed customer. First, decide what factors are most important to you in selecting a pharmacy. Here are some things to think about in addition to cost:

• Is a pharmacist available to answer questions?

• Are you responsible for co-payment, or will the pharmacy waive it?

• Will the pharmacist bill Medicare and/or private insurance companies?

• Will the pharmacy complete the insurance claim forms and wait for reimbursement or will you have to pay up-front?

• Does the pharmacy routinely stock cyclosporine (Sandimmune & Neoral) and Prograf? If not, how much notice does it require to get it?

• Does the pharmacy deliver free of charge?

• Are the pharmacy hours convenient for you?

• How long is the turnaround time from when the pharmacy receives the prescription to when you receive the medication? Consider this factor especially if you use a mail order pharmacy!

In September 1994, TRIO New England members polled several major pharmacies for their resource publication. Their findings point out the wide range in prices and services and the value of conducting your own survey. In April 1996 the TRIO Nation's Capital Area Chapter conducted a survey in the Washington, DC metropolitan area. The results show a wide range of pricing. And don't overlook the neighborhood pharmacist in your search. You may be pleasantly surprised. Finally, be sure to talk to your doctor about generic drugs. While generics may not yet be available for the standard immunosuppressive drugs, they may be available for other medications you are required to take. And as you can see on the following tables, the savings for generic drugs can be significant. Also please note the pricing changes for each drug over the two "survey" years.

Please see TABLE 1 (1994 New England TRIO Chapter survey)

TABLE 2 (1996 Nation's Capital Area TRIO Chapter survey)

The patient taking many drugs always experiences a significant financial impact. It is not unusual to have an annual drug bill of $8,000 to $12,000 (or more). Many insurance plans include these costs in your lifetime limit. It is therefore in your best interest to be mindful of these limits when purchasing drugs. You are encouraged to perform your own pricing survey. Current organ and tissue recipients will usually share their experiences in this area, and remember, insurance is a big factor in each recipient's decision.

The TRIO-NCAC 1996 survey discovered the lowest prices at "membership" organizations. Remember, the savings on one order of an immunosuppressive drugs often will cover the annual membership fee for a buying "club". Likewise, membership in any organization with a prescription plan is well worth investigating. Some of their membership criteria are quite flexible. Look at a family membership of several generations, especially when it offers you an advantage.

Mail order pharmacies are a consideration for obtaining your many drugs. Some of these are active supporters of transplantation and even publish regular newsletters for transplant recipients.

American Preferred Plan
800-227-1195
APP provides links to community resources and national support networks.

CHRONIMED Pharmacy
13911 Ridgedale Drive
Minnetonka, MN 55305
800-888-5753 / 612-541-0239
http://www.chronimed.com
FAX: 612-513-6151
e-mail: hsvendsen@chronimed.com
Chronimed provides the "Transplant Support Group Directory" and other educational and support materials.

Continental Health Care & Lifesource Integrated Services
15673 NEO Parkway
Cleveland, OH 44128
800-776-4633
800-333-1277 / 216-475-8008
FAX: 216-475-4706

Express Pharmacy Services
P.O. Box 94999
Birmingham, AL 35220-9989
800-826-8850

HMI Pharmacy Services
P.O. Box 29423
New York, NY 10087-9387
202-737-5481
800-673-5633
FAX: 516-981-0801

HMI Maryland, Inc.
5500 Hartford Road
Baltimore, MD 21214
800-464-6080

Stadtlander's Pharmacy
600 Penn Center Boulevard
Pittsburgh, PA 15235
800-238-7828
FAX: 412-825-1419
http://www.stadtlander.com
e-mail: stadt@stadtlander.com
Stadtlander's provides a support group directory. Publishes LifeTimes quarterly. Free to customers. See References periodicals section for more information.

Sears Health Trends (call for local pharmacy location and address for Mail Orders)
Customer Service Department
P.O. Box 24843
Omaha, NE 68124-0843
800-955-2560
Mail Order Pharmacy or location of nearby local participating pharmacies 800-374-MEDS / (800-374-6337) For variable discount on drugs from many local pharmacies and by mail order; discount on eyeglasses (800-967-3937), vitamin & Healthcare products (800-955-2560) and hearing aids (800-955-2560); there is an annual family membership fee.

AARP Pharmacy Service Center
Department 992172
P.O. Box 40011
Roanoke, VA 24022-9911
800-456-2226
800-456-7821
For those age 50 and over, or with a family member age 50 or over. There is an annual membership fee.

Don's Uptown Pharmacy
The Pharmacist is "Harvey"
Phoenix, AZ 800-775-6888
Reportedly waives the co-pay, up to 20%.

W. 14th Prescription Center
212-727-7979
Reportedly waives the co-pay, up to 20%.

A hint on refills: ask your doctor for refill prescriptions of 100 pills or capsules, rather than a monthly (30 day) supply. The savings can be worthwhile. But be aware that as you progress through your recovery, many of your medications will be changed, reduced or eliminated altogether. So before refilling a 100 pill prescription, make sure to check whether you will be taking the medication long enough to use it all. Otherwise, you'll be flushing a lot of unused and expensive drugs down the drain.