How Regence member Sherry M. simplified prescription pickups, lowered costs with help from a care manager

Regence member Sherry M. dreamt of visiting new places around the world. But just traveling to the local pharmacy was difficult.

Sherry, who lives in Washington State, is diagnosed with psoriatic arthritis (PSA), diabetes, asthma, and an immunocompromised system. She manages 10 to 12 medications at a time and takes precautions to protect her weakened immune system from infection.

Picking up prescriptions meant driving into town and standing in long lines surrounded by other sick people, often while she felt unwell.

“I’m wearing a mask, standing there with a cane,” she says. “And [my doctors] can never get them aligned right, so I’m in there, like, twice a week.”

Prescriptions made easier, more affordable

Enter Cody C., MSN, RN, CCM, a Regence nurse care manager.  Data systems had identified Sherry for Care Management services, flagging Sherry’s multiple conditions and high-cost medications to Cody.

After Cody connected with Sherry on the phone, he offered to help her manage treatment plans and prescriptions, including a specialty medication, Cosentyx, that keeps her PSA from progressing and costs $7,400 per month.

“With that drug in particular, we worry about our members getting their medication and being able to stay on it and afford it,” Cody says.

That concern was well-founded. Sherry hadn’t realized her co-pay assistance program required an annual renewal. Without it, her out-of-pocket costs were significant. Cody walked her through re-enrolling in the assistance program and connected her with Accredo Pharmacy, a specialty mail-order service that delivers Cosentyx, a temperature-sensitive medication, directly to her door.

Cody then took it a step further, working with Sherry’s doctors to transition all her prescriptions to a 90-day supply delivered to her home through the mail-order program Express Scripts. The switch saved her time, money and protected her health.

An advocate who cares

But the pharmacy solution was just the beginning.

Over the past year, Cody helped Sherry navigate referrals, locate in-network specialists, research treatment options for a painful bone spur, and resolve billing errors.

While recuperating from COVID-19, Sherry was overwhelmed with texts, calls and emails from a specialist’s office requesting lab work. Cody stepped in.

“He called over there and said, ‘She’s dealing with COVID,’ Sherry recalls. ‘You’re going to get her labs when she’s clear. She’s resting. You need to stop calling her.’  And they did. They left me alone. He’s like a savior to me.”

“Person in my corner”

When Sherry’s rheumatologist moved out-of-network, increasing her costs, Cody supported her decision to find a provider who better met her needs. He searched for an in-network rheumatologist and advocated with the scheduler to get her seen sooner, capitalizing on a last-minute cancellation to move the appointment up months earlier than expected.

When Sherry’s father died, Cody offered support and shared mental health resources for grieving.

Sherry calls Cody the “Regence answer man.”

“He’s the person in my corner,” she says. “He’s a miracle worker.”

Dreams take flight

Sherry is now turning her travel dream into reality. In partnership with Cody and her doctors, she and her husband are planning an airline trip to celebrate their anniversary. It will be Sherry’s first time on a plane since 2019.

Cody says he’s helping Sherry plan how to travel safely with her complex conditions and many medications. He’s working with her care team to get prescription bottles that meet TSA’s travel requirements. He’s also encouraging lifestyle modifications, including aqua therapy and the Mediterranean diet, to keep her PSA as manageable as possible while traveling.

Sherry is passionate about helping other Regence members discover care management.

“There’s something in there that would benefit everyone,” she says. “I promise you.”