Pick a card, pick a plan
How and where to get financial support to help pay for your meds
by Jeff Berry
Updated from the March/April 2010 Positively Aware HIV Drug Guide.
With the ongoing economic crisis, plus the large number of people who are unemployed, and the mounting costs associated with health care, patient assistance and drug co-pay programs may be a way to offer much-needed assistance to those who are uninsured and underinsured, or are being adversely affected by the rising costs of drug co-pays, health insurance premiums, and other expenses associated with health care.
Most, if not all, pharmaceutical companies already provide some level of patient assistance to individuals who are unable to afford their HIV medications. These are typically for uninsured patients only and those who qualify financially. Qualifications vary by program, so individuals and care providers should contact the manufacturer directly to see if an individual is eligible for a specific patient assistance program, or PAP (see sidebar).
Many companies have also recently instituted co-pay assistance programs for their HIV drugs. Co-pay programs may cover all or part of the drug co-pay for many privately-insured individuals, up to a specified amount, and for a pre-determined period of time (for example, up to one year). Certain restrictions and eligibility requirements apply (for example, recipients of ADAP, Medicare, and Medicaid are ineligible), and eligibility requirements may vary from program to program. Individuals usually get their co-pay cards directly from their provider, or in some cases from the manufacturer’s website or by calling a toll-free number. Once enrolled, they then bring the co-pay card to the pharmacy when filling the prescription, and the pharmacy is reimbursed for the amount covered. People who reside in the state of Massachusetts by law are not eligible for drug co-pay programs.
These co-pay programs are the direct result of several years of intense work and negotiations between the Fair Pricing Coalition (FPC) and representatives of the pharmaceutical industry. The FPC, founded by the late Martin Delaney, works with the drug companies on HIV drug pricing issues in an effort to help control costs and improve access to life-saving medications.
Major health insurance carriers contract with Prescription Benefit Managers (PBMs) to reduce health care costs through the use of mail-order pharmacies. Unfortunately many of the most widely used mail-order pharmacies in the U.S. do not accept co-pay cards, either because their systems are not set up to handle them or they don’t have the software to process this type of reimbursement. This is a problem since more and more patients are required by their company’s health care plan to acquire their medications through a mail-order pharmacy, and it’s an issue that the Fair Pricing Coalition continues to work to address with each individual company.
There may be medications in addition to HIV drugs that individuals have to take, including those needed to control other conditions such as high cholesterol or diabetes. To find patient assistance or drug co-pay programs for these and other types of drugs, visit www.pparx.org or www.needymeds.com.
Together Rx is a prescription saings program for uninsured individuals sponsored by many of the nation’s leading pharmaceutical companies. For more information call toll-free 1-800-966-0407, or enroll online at www.TogetherRxAccess.com.
Additional co-pay and/or patient assistance programs are available for hepatitis B and hepatits C drugs, as well as some medications or treatments used for other HIV-related conditions such as lipodsystrophy. Contact the manufacturer directly or visit www.positivelyaware.com and enter “co-pay programs” in the search box for more information.
Below is a brief description of currently available HIV co-pay programs. For more information, or if you have a problem accessing or using a specific program, call the Project Inform Hotline at 1-800-822-7422, or call the number listed for that program. Visit www.positivelyaware.com for more information, as this article is regularly updated as details of specific programs change.
HIV Drug Co-pay Programs*
Abbott: Positive Partnership PLUS Card—This program includes 12 months of co-pay savings and covers Kaletra plus up to two other ARVs, no income or co-pay eligibility criteria. Patients can save up to $50 per month toward their Kaletra co-pay, plus up to $100 of the cost of other HIV medications (up to $50 for each additional ARV with a limit of $100 total—must be part of a Kaletra regimen). Patients must get their card from their provider. Call toll-free 1-800-556-8317 or visit www.kaletra.com for more information. Abbott has announced that it will be launching a Norvir co-pay program in 2010 which will cover co-pays from $25-75.
Boehringer Ingelheim: Viramune Co-Pay Savings Card—Covers Viramune; card is valid for amount of patient’s out-of-pocket cost up to $50 per month, for a total of 12 months. Patients must get card from their health care provider. The card is in the form of a MasterCard debit card, which can be activated at www.viramune.com or by calling the toll-free number on the card. Debit card should be accepted at any pharmacy which accepts MasterCard, and most mail-order pharmacies as well.
Bristol-Myers Squibb: Reyataz and Sustiva Co-Pay Benefit Program—Covers Reyataz and Sustiva; any amount up to $200 per month for each drug. If health care provider does not have card, patients can call toll free 1-888-281-8981; visit www.bms.com.
Bristol-Myers Squibb and Gilead Sciences: Atripla Co-Pay Assistance Program—Covers Atripla; for high co-pays only. Patient responsible for first $50 plus any amount over $250. If health care provider does not have card, patients can call toll-free 1-866-784-3431 and one will be mailed to them; visit www.atripla.com.
Genentech/Roche: Company does not offer co-pay assistance for HIV medications. However, they do provide patient assistance for both Invirase and Fuzeon. Call 1-877-757-6243 or visit www.roche.com for more information.
Gilead Sciences: Truvada Co-Pay Assistance Program—Covers Truvada, Emtriva, and Viread. For high co-pays only; kicks in above $50 and up to $200/month. If health care provider does not have the card, patients can call toll-free 1-888-358-0398 and one will be mailed to them.
GlaxoSmithKline: See ViiV Healthcare
Merck & Co.: Isentress Patient Savings Coupon Program—Covers Isentress; patient is responsible for the first $30 of out-of-pocket cost. The coupon provides savings towards out-of-pocket cost over $30 up to a maximum of $400 per prescription (regardless of the number of tablets supplied on the prescription) Visit www.isentress.com or call toll-free 1-866-350-9232. (Residents of Colorado and Massachusetts not eligible by law.)
Pfizer: See ViiV Healthcare
Tibotec: Tibotec Therapeutics Patient Savings Program—Covers Prezista and Intelence. Saves up to 80% of the amount of your actual out-of-pocket cost up to $100 per drug, per month. Visit www.prezista.com/prezista/patient_assistance.html or call toll-free 1-866-961-7169.
ViiV Healthcare: MySupportCard—All former GSK and Pfizer HIV drugs are covered (Combivir, Epivir, Epzicom, Lexiva, Rescriptor, Retrovir, Selzentry, Trizivir, Viracept, and Ziagen). This is still the easiest program to qualify for and to access, with no income criteria. Card is valid for the amount of patient’s actual out-of-pocket cost up to a maximum of $100 for each prescription. Patients can use their current or new card for both Pfizer and GSK drugs, now under one umbrella at ViiV Healthcare. You can get the card from your provider or print out the card online at www.mysupportcard.com, or visit www.gskforyou.com. Call 1-888-825-5249.
For more detailed information on specific co-pay and patient assistance programs, click here
*By law, residents of the state of Massachusetts are not eligible for drug co-pay programs. There is legislation pending in the House which, hopefully, will address this issue.
Special thanks to David Evans and the Fair Pricing Coalition for some of the information contained in this article. Note: The author is a member of the Fair Pricing Coalition.