Did you know that in terms of medication, multiple sclerosis is the second most expensive chronic disease to treat? Health-related costs average $57,500 per year with lifetime costs of more than $3.7 million. The cost of disease modifying treatments average $35,000/year alone. Insurance helps, but what if you have limited prescription coverage, high co-payment requirements, or no insurance at all?
Most pharmaceutical companies have assistance programs which help patients obtain their medication at a reduced cost. The drug companies really want you to use their medications, so they have programs set up to navigate insurance coverage, maximize reimbursement, and lower out-of-pocket costs for the patient. In this issue of eMS News we are going to briefly examine several payment assistance programs.
Copaxone Patient Assistance Program – Teva Pharmaceuticals
In June Teva implemented a new co-pay solution for patients with commercial health insurance (non-Medicaid & non-Medicare) that helps reduce co-pays to $35 per month, out of pocket. There are no income qualifications, but patients need to have a co-pay of $535 or less. For uninsured patients Teva offers assistance in partnership with AssistRX. There are also assistance programs for people using Medicare Part D. To learn about any of these options, contact Shared Solutions at 1-800-887-8100
Betaseron Patient Assistance Program – Bayer Pharmaceuticals
For patients with commercial health insurance, Bayer usually pays 100% of the co-pay. Patients will continue to receive Betaseron for free as long as they are on the therapy. They do not have to re-enroll or reapply after one year. The only time they have to re-enroll is if their insurance changes. The maximum per year patient benefit is $9500. There are no income qualifications for this program. Through another payment assistance program, uninsured or underinsured patients will pay no more than $50 dollars per month. To learn about any of these options, contact BetaPlus at 1-800-778-1467
Ampyra Patient Assistance Program – Acorda Therapeutics
Patients with commercial insurance can sample Ampyra for free for 60 days. After that, if the medication helps, patients will only pay $40 of whatever their co-pay is. Medicare patients can apply for patient assistance, which is funded by Acorda and is based on income levels. If the patient qualifies, Ampyra is free for that calendar year. Colorado Medicaid covers Ampyra, making it free to Medicaid patients with MS and walking difficulty.
Rebif Patient Assistance Program — EMD Serono, Inc.
The MS LifeLines Reimbursement Specialists can answer questions on topics including enrollment, benefits and prior authorization requirements for a variety of health insurance and prescription drug programs. If you currently have health insurance, they’ll work with you to help you get the best available coverage under your insurance plan. If you have questions about affording your therapy or if you have no insurance or limited insurance, MS LifeLines Reimbursement Specialists will help get you connected with the appropriate assistance programs, as well as appropriate state or federal programs. Call MS LifeLines Access Made Simple at 1-877-447-3243
Avonex and Tysabri Access Programs – Biogen Idec
Biogen offers patient assistance through its ActiveAccess Services. This program offers insurance counseling to help patients obtain adequate coverage, along with help navigating changes due to the new healthcare reform law. It can also include $10 Copay Programs with no income requirements and no enrollment time limit for eligible patients, infusion cost assistance program for eligible patients, and free medication for eligible patients in need. To learn more about ActiveAccess or the cost and insurance assistance programs, call an ActiveSource Coordinator at 1-800-456-2255.
Gilenya – Novartis Pharmaceuticals Corporation
If you are unable to afford Gilenya or don’t have health coverage, the Novartis Patient Assistance NOW might be able to help. If you have commercial health insurance, the Gilenya Go Program will cover your out-of-pocket costs up to $800 per prescription benefit and $10,400 per calendar year. This co-pay assistance program is available for eligible people who have been prescribed Gilenya, regardless of income level or medical history. The co-pay assistance program will also cover up to $600 per year for additional medical expenses associated with Gilenya treatment. To learn more about Patient Assistance NOW or the Gilenya Go Programs, call 1-800-445-3692.
Ask Your Doctor for Help
Lastly, let your doctor know that the cost of medication is an important consideration for you. He or she might be able to suggest an equivalent medication, have a staff member help you fill out paperwork to one of the patient assistance programs or know of another solution, such as an open-label clinical trial.