Cost Is an Adherence Barrier — Here's How to Help

When patients can't afford their medications, they don't take them. For patients on Mestinon (Pyridostigmine Bromide), medication cost and availability are increasingly becoming barriers to consistent treatment — particularly for the extended-release formulation, which has seen both supply shortages and significant price increases.

As a prescriber, you're in a unique position to help patients navigate cost challenges before they lead to missed doses, disease flares, or emergency department visits. This guide provides a practical framework for identifying savings opportunities and integrating cost conversations into your clinical workflow.

What Patients Are Paying for Mestinon

Understanding the cost landscape helps you anticipate which patients may need financial assistance:

Generic Pyridostigmine Bromide IR (60 mg)

• Cash price: $50–$150 for 90 tablets
• With discount card: $26–$50 for 90 tablets
• With insurance: Typically covered as a Tier 1 or Tier 2 generic; copays usually $5–$30

Generic Pyridostigmine Bromide ER (180 mg)

• Cash price: $700–$750 for 30 tablets
• With discount card: $105–$150 for 30 tablets
• With insurance: May require prior authorization or step therapy through IR first; copays vary widely from $20–$100+

Brand Mestinon Timespan (180 mg ER)

• Cash price: Significantly higher than generic
• Insurance: Often requires prior authorization; may not be covered

The cost differential between the IR and ER formulations is substantial. Patients taking the ER formulation — especially those paying cash or with high-deductible plans — are at the highest risk for cost-related nonadherence.

Manufacturer Savings Programs

Bausch Health, the manufacturer of brand-name Mestinon, does not currently offer a specific copay savings card for Mestinon. However, they do offer a Patient Assistance Program (PAP):

Bausch Health Patient Assistance Program

• Eligibility: Uninsured or underinsured patients who meet income requirements
• What it provides: Free brand-name medication for qualifying patients
• How to apply: Through bauschhealthpap.com or by contacting Bausch Health directly
• Provider role: You'll need to complete a prescription section on the application and provide clinical documentation

For patients who don't qualify for the PAP, the generic versions are almost always the more cost-effective route.

Coupon and Discount Cards

Discount cards can significantly reduce out-of-pocket costs for uninsured patients or those with high copays. These are free to use and accepted at most pharmacies:

• GoodRx — Typically shows Pyridostigmine IR 60 mg at $26–$45 for 90 tablets. The ER formulation prices are higher but still substantially below cash price.
• SingleCare — Competitive pricing, especially at certain chains like CVS and Walmart.
• RxSaver — Compares prices across nearby pharmacies.
• Optum Perks — Another option with broad pharmacy acceptance.
• BuzzRx, America's Pharmacy, ScriptSave WellRx — Additional discount programs worth checking.

A practical tip: recommend that patients compare prices across 2–3 discount platforms, as pricing varies by pharmacy and can change week to week. Medfinder for Providers can also help you and your staff quickly check availability and pricing.

Additional Resources for Financial Hardship

• NeedyMeds (needymeds.org) — Comprehensive database of patient assistance programs, discount cards, and disease-specific resources
• RxAssist (rxassist.org) — Directory of pharmaceutical company assistance programs
• RxHope (rxhope.com) — Application portal for multiple manufacturer PAPs

Generic Alternatives and Therapeutic Substitution

Since generic Pyridostigmine is available, cost-based therapeutic substitution is primarily relevant when patients can't access a specific formulation:

IR vs. ER Formulation Switching

If a patient can't afford or find the ER 180 mg formulation, switching to the IR 60 mg tablets taken in divided doses is a clinically reasonable alternative. The IR version is more available and significantly cheaper. The trade-off is a more complex dosing schedule (every 4–6 hours vs. once or twice daily), which may affect adherence differently depending on the patient.

When making this switch, consider:

• The 180 mg ER tablet is not equivalent to three 60 mg IR tablets taken at once — the release profiles are different
• Patients may need to take the last IR dose later in the evening to cover overnight symptoms previously managed by the ER dose at bedtime
• Monitor closely during the transition for breakthrough symptoms

Alternative Cholinesterase Inhibitors

If Pyridostigmine is unavailable or poorly tolerated, limited alternatives exist:

• Neostigmine (Prostigmin) — Shorter duration of action, more pronounced side effects, but may be an option in acute situations
• Ambenonium (Mytelase) — Longer acting but very limited availability

For a complete overview of alternatives, see our clinical alternatives guide.

Building Cost Conversations into Your Workflow

Research consistently shows that patients rarely bring up medication costs on their own. Proactively addressing cost can improve adherence and outcomes:

At the Point of Prescribing

• Ask about insurance coverage: "Do you have prescription drug coverage? Do you know your copay tier for this medication?"
• Mention the generic: "I'm prescribing the generic version — Pyridostigmine — which is significantly cheaper than the brand name."
• Discuss formulation cost: "The extended-release version is more expensive and sometimes harder to find. Let's start with the immediate-release and see how it works for you."

At Follow-Up Visits

• Check for cost-related nonadherence: "Have you been able to fill your Mestinon without any problems? Is the cost manageable?"
• Reassess formulation: If a patient is on the ER and struggling with cost, discuss switching to IR
• Update discount card recommendations: Pricing changes — what was cheapest six months ago may not be today

Staff-Level Interventions

• Train your MA or nurse to ask about cost barriers during intake
• Keep a list of discount card options at the checkout desk or in the EHR as a patient handout
• Use Medfinder for Providers to quickly check local pharmacy stock before sending prescriptions
• Designate a staff member to assist with PAP applications when needed

For the EHR

Consider adding a standardized note template for cost discussions:

• Insurance status and drug coverage confirmed
• Generic prescribed (yes/no)
• Discount card discussed (yes/no)
• PAP eligibility screened (yes/no)
• Availability checked via Medfinder or pharmacy (yes/no)

Final Thoughts

Medication cost shouldn't be the reason a myasthenia gravis patient has a flare. With generic Pyridostigmine widely available at $26–$50 for the IR formulation, most patients can afford treatment — but only if they know about discount cards, assistance programs, and the cost differences between formulations.

As a prescriber, a two-minute conversation about cost at the point of prescribing can prevent weeks of nonadherence down the line. And tools like Medfinder for Providers make it easy to check stock and help patients fill their prescriptions without delays.

For the patient-facing version of this information, see our patient savings guide for Mestinon.