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HIV HEPATITIS-B HEPATITIS-C RELATED CONDITIONS

THE COST OF
LIVING

Assistance programs help pay for meds

By Jeff Berry and John Peller

Treatment for HIV is expensive, but the good news is that help is out there! Several non-profit organizations and even the pharmaceutical companies themselves have programs to help you pay for the treatment you need.

Co-pay and Patient Assistance Programs

Most pharmaceutical companies provide some level of assistance through a patient assistance program (PAP) for people who can’t afford their HIV medications. These PAPs are typically for patients without insurance who don’t qualify for Medicare, Medicaid, or ADAP. Qualifications and criteria vary by program and are based on a percentage of Federal Poverty Level (FPL). Patients or providers should contact the program to see if they are eligible (see charts below).

Many companies also have co-pay assistance programs for those who have drug coverage through privately held insurance. These programs may cover all or part of the drug co-pay up to a specified amount. Certain restrictions and eligibility requirements apply (for example, recipients of ADAP, Medicare, and Medicaid are not eligible). Individuals can get the co-pay card directly from their provider, the manufacturer’s website, or by calling a toll-free number. Some programs have a reimbursement process in case you are forced to pay the co-pay out of pocket if the pharmacy can’t or won’t accept the card. And some PAPs will make exceptions; for example, for a person on ADAP who has insurance but who has a high deductible, they may cover a certain percentage. Check with each program for details.

The Affordable Care Act

The Affordable Care Act (ACA, commonly referred to as “Obamacare”) will improve access to coverage for many people with HIV. Although the new law is far from perfect, the ACA’s intention to provide more affordable benefits will allow many people with HIV to address their health needs. Beginning this year, insurers won’t be able to deny coverage to people with HIV/AIDS or impose annual limits on coverage. Low- and middle-income earners may be eligible for tax subsidies to help them buy coverage from health insurance exchanges, or marketplaces. In 26 states that haven’t refused it (as of January 2014), Medicaid eligibility will expand to generally include those under 65 with incomes below 133% of the federal poverty level ($15,282 for an individual; $31,322 for a family of four).

Advocates across the country have raised concerns about the high cost of some HIV drugs available through some exchange plans. Although plans with affordable HIV drug coverage co-pays exist in almost all areas, individuals who select the wrong plan may have to pay $1,000 or more (up to 50%) in co-insurance for HIV drugs for several months out of the year. Make sure you know what your plan will cost in terms of co-insurance and deductibles, as well as the monthly premium. In addition, some plans do not cover all HIV medications. To make sure your drugs are included on the formulary of the plan you choose; have a list of all your meds, for HIV and any other condition, and ask specifically if they are covered.

Fortunately, many state AIDS Drug Assistance Programs (ADAPs)  can help pay out-of-pocket costs for HIV drugs obtained through some exchange plans. ADAPs can also help pay premiums in some states. Check with your state ADAP to learn what your state offers, as well as the income limits. If you’re not eligible for ADAP, you may be able to use co-pay cards to make medications more affordable.

It is critical to consult a trained enrollment “navigator,” when choosing an exchange plan. Contact your local HIV/AIDS service organization for help or a referral.

Advocates are pressing for clarity from the administration as to whether or not qualified health plans (QHPs) purchased through a health insurance exchange are considered government programs, which would therefore make policyholders ineligible to receive co-pay assistance. As this issue went to press, several companies have interpreted it this way and are currently excluding people with QHPs from co-pay coverage.

Medicare Part D

The Affordable Care Act provides for closing the Medicare Part D prescription drug benefit “donut hole” by 2020. Beneficiaries receive a 50% discount on covered brand-name drugs while they are in the “donut hole,” with increased savings on prescription drugs while they are in the coverage gap until the gap is fully closed. In addition, ADAP benefits are now considered as contributions toward Medicare Part D’s True Out of Pocket spending limit (“TrOOP”), so ADAP clients who have Medicare Part D should be able to benefit.

Harbor Path and the Common PAP Form

HarborPath is a non-profit organization that helps uninsured people living with HIV/AIDS and/or hepatitis C to gain access to brand-name prescription medicines at no cost, by providing case managers with a single online portal for PAP applications and medication fulfillment through a mail-order pharmacy. Go to harborpath.org.

The Department of Health and Human Services (DHHS), along with seven pharmaceutical companies, the National Alliance of State and Territorial AIDS Directors (NASTAD), and community stakeholders developed a common patient assistance program application that can be used by both providers and patients, instead of filling out different sets of paperwork for each company PAP. To download the form, go to hab.hrsa.gov/patientassistance.

Additional programs

Co-pay and patient assistance programs are also available for hepatitis B and C drugs, and medications or treatments used for other HIV-related conditions such as lipodystrophy—some of these are included in the co-pay and PAP charts at right.

To learn more about patient assistance or co-pay programs for drugs used to treat certain opportunistic infections or other conditions, talk to your provider, contact the manufacturer directly, or go to pparx.org and needymeds.org. SurvivorRxPlan offers help in getting many medications not covered by ADAP, including alternative therapies and generics, even if you receive medicines through another discount program. It is available to individuals with incomes of up to $36,425, and higher based on family size. Go to SurvivorRxPlan.com.

JUMP TO THE CHARTS

HIV HEPATITIS-B HEPATITIS-C RELATED CONDITIONS

Stay informed and up to date

Keeping the lines of communication open between you and your health care provider, pharmacist, and case manager is essential when managing your health, so stay informed. Use the chart below to check specific details.


John Peller is Interim President/CEO of AIDS Foundation of Chicago.

HIV Co-pay and Patient Assistance Programs (PAPs)

Drug COMPANY CO-PAY PROGRAM PATIENT ASSISTANCE DETAILS
Aptivus Boehringer Ingelheim N/A 800-556-8317 / rxhope.com or pparx.com Patient assistance program only.
Atripla Bristol-Myers Squibb and Gilead 866-784-3431 / atripla.com 866-290-4767 atripla.com Co-pay program covers up to $400 per month per prescription. Card available through provider.
Combivir ViiV Healthcare 877-844-8872 / mysupportcard.com 877-784-4842 / viivhealthcareforyou.com Co-pay program covers up to $200 per month per prescription. Card available online at mysupportcard.com or through provider.
Complera Gilead Sciences and Janssen Therapeutics 877-505-6986 / complera.com 800-226-2056 / gilead.com/us_advancing_access

Co-pay program covers up to $400 per month per prescription. Card available through your provider, AIDS service organization, and pharmacy.

Crixivan Merck & Co. None. 800-850-3430 merck.com/merckhelps Patient assistance program only.
Edurant Janssen Therapeutics 866-961-7169 / edurant-info.com 800-652-6227 / jjpaf.org

Co-pay: patient pays first $5, then rest of co-pay is covered; no cap. Card available through your provider or at janssentherapeutics.com.

Emtriva Gilead Sciences 877-505-6986 / truvada.com 800-226-2056 / gilead.com/us_advancing_access

Co-pay program covers up to $200 per month per prescription. Card available through your provider, AIDS service organization, and pharmacy.

Epivir
(lamivudine)
ViiV Healthcare 877-844-8872 / mysupportcard.com 877-784-4842 / viivhealthcareforyou.com Co-pay program covers up to $200 per month per prescription. Card available online or through provider.
Epzicom ViiV Healthcare 877-844-8872 / mysupportcard.com 877-784-4842 / viivhealthcareforyou.com Co-pay program covers up to $200 per month per prescription. Card available online or through your provider.
Fuzeon Genentech/Roche N/A 866-257-5084 / fuzeon.com

Genentech Access to Care Foundation for un- and under-insured.

Intelence Janssen Therapeutics 866-961-7169 / intelence.com 800-652-6227 / intelence.com or jjpaf.org

Co-pay: patient pays first $5, then rest of co-pay is covered; no cap. Must re-apply annually. Card available through your provider or at janssentherapeutics.com.

Invirase Genentech N/A N/A No company programs.
Isentress Merck & Co. 866-350-9232 / isentress.com 800-850-3430 / isentress.com

Co-pay program covers up to $400 per month per prescription. Card available online or through provider.

Kaletra AbbVie, Inc. 800-441-4987 / kaletra.com 800-222-6885 / kaletra.com, or abbviepaf.org

Co-pay program covers up to $200 per month per prescription. Must re-apply annually. Card available online or through provider. 30-day sample program available.

Lexiva ViiV Healthcare 877-844-8872 / mysupportcard.com 877-784-4842 / viivhealthcareforyou.com

Co-pay program covers up to $200 per month per prescription. Card available online or through provider.

Norvir AbbVie, Inc. 800-441-4987 / norvir.com 800-222-6885 / abbviepaf.org Co-pay program covers up to $50 per month per prescription. Card available through provider.
Prezista Janssen Therapeutics 866-961-7169 / prezista.com 800-652-6227 / jjpaf.org Co-pay: patient pays first $5, then rest of co-pay is covered; no cap. Card available through your provider or at janssentherapeutics.com.
Rescriptor ViiV Healthcare 877-844-8872 / mysupportcard.com 877-784-4842/  viivhealthcareforyou.com Co-pay program covers up to $200 per month per prescription. Card available online or through provider.
Retrovir
(zidovudine)
ViiV Healthcare 877-844-8872 / mysupportcard.com 877-784-4842/  viivhealthcareforyou.com

Co-pay program covers up to $200 per month per prescription. Card available online or through provider. For Retrovir only, not generic.

Reyataz Bristol-Myers Squibb 888-281-8981 / reyataz.com 888-281-8981 / bms.com

Co-pay program covers up to $200 per month per prescription. Card available online or through provider or by calling the toll-free number.

Selzentry ViiV Healthcare 877-844-8872 / mysupportcard.com 877-784-4842 / viivhealthcareforyou.com Co-pay program covers up to $200 per month per prescription. Card available online or through provider.
Stribild Gilead Sciences 877-585-6986 / stribild.com 800-226-2056 / stribild.com

Co-pay program covers up to $400 per month per prescription. Card available through your provider.

Sustiva Bristol-Myers Squibb 888-281-8981 / sustiva.com 888-281-8981 / bms.com Co-pay program covers up to $200 per month per prescription. Card available through provider, or by calling toll-free number.
Tivicay ViiV Healthcare 877-844-8872 / mysupportcard.com 877-784-4842 / viivhealthcareforyou.com Co-pay program covers up to 400 per month per prescription. Card available online or through provider.
Trizivir ViiV Healthcare 877-844-8872 / mysupportcard.com 877-784-4842 / viivhealthcareforyou.com

Co-pay program covers up to $200 per month per prescription. Card available online or through provider. Must re-enroll and get new card for 2013.

Truvada Gilead Sciences 877-505-6986 / truvada.com 800-226-2056 / gilead.com/us_advancing_access

Co-pay program covers up to $200 per month per prescription. Card available through your provider, AIDS service organization, and pharmacy.

Videx EC
(didanosine)
Bristol-Myers Squibb None. bms.com

No company co-pay or patient assistance program for Videx. Available as generic.

Viracept ViiV Healthcare 877-844-8872 / mysupportcard.com 877-784-4842 / viivhealthcareforyou.com

Co-pay program covers up to $200 per month per prescription. Card available through your provider, AIDS service organization, and pharmacy.

Viramune XR Boehringer Ingelheim 877-411-8641 / viramunexr.com 800-556-8317 / needymeds.org

Co-pay program for Viramune XR only: Patient pays first $25; no cap. Card available through your provider. No co-pay or PAP for Viramune (IR); available as generic.

Viread Gilead Sciences 877-505-6986 / truvada.com 800-226-2056 / gilead.com/us_advancing_access

Co-pay program covers up to $200 per month per prescription. Card available through provider.

Zerit
(stavudine)
Bristol-Myers Squibb None. bms.com No company co-pay or patient assistance program for Zerit. Available as generic.
Ziagen ViiV Healthcare 866-747-1170 / mysupportcard.com 877-784-4842 / viivhealthcareforyou.com Co-pay program covers up to $200 per month per prescription. Card available online or through provider.

OTHER co-pay & patient assistance programs (PAPs)*

*By law residents of the state of Massachusetts
are not eligible for drug co-pay programs.

Hepatitis B

Drug COMPANY CO-PAY PROGRAM PATIENT ASSISTANCE DETAILS
Baraclude Bristol-Myers Squibb 855-898-0267 855-898-0267 / bmspaf.org Co-pay program covers $200 per month, per prescription. Ask operator to speak to someone about the Baraclude Co-pay Discount Benefits Program, and have card mailed to you. Program runs through Dec. 31, 2014.
Epivir-HBV ViiV Healthcare mysupportcard.com 866-475-3678 /gskforyou.com Co-pay program covers $200 per month, per prescription.
Hepsera Gilead Sciences None. 800-226-2056 /
gilead.com/us_advancing_access
PAP only, no co-pay program.
Tyzeka Novartis None. 800-277-2254 /
pparx.org
PAP only, no co-pay program. PAP is through Novartis Patient Assistance Foundation, Inc.
Viread Gilead Sciences 877-627-0415 800-226-2056 / gilead.com/us_advancing_access Co-pay program covers after first $50 and up to $200 per month for patients who are uninsured or pay their prescription costs in full.

Hepatitis C

Drug COMPANY CO-PAY PROGRAM PATIENT ASSISTANCE DETAILS
Copegus
(ribavirin)
Genentech None. 888-941-3331 / pegasysaccesssolutions.com PAP only, no co-pay program.
Incivek Vertex Pharmaceuticals 855-837-8394 / incivek.com 855-837-8394 / incivek.com Co-pay program covers co-pay costs up to $10,000 for those who have private insurance, regardless of income.
Olysio Janssen Pharmaceuticals 855-5-OLYSIO (65-9746) / olysio.com 800-652-6227 / jjpaf.org Co-pay coupon program covers out of pocket costs to $25,000. PAP is for those not qualified for other assistance up to 500% FPL.
Pegasys
(peginterferon alfa-2a)
Genentech None. 888-941-3331 / pegasysaccesssolutions.com Co-pay program through other non-profits.
Pegasys
(peginterferon alfa-2a)
Genentech None. 888-941-3331 / pegasysaccesssolutions.com Co-pay program covers up to $200 per month, per prescription.
Sovaldi Gilead Sciences 855-769-7284 mysupportpath.com Co-pay program covers up to $16,000, maximum $5 co-pay charge per prescription. PAP covers those not qualified for other assistance with a household income of up to $100,000 per year (1-3 people) and 500% FPL (4 or more).
Victrelis Merck & Co. 866-939-4372 / victrelis.com 866-363-6379 / merckhelps.com Co-pay program covers up to 20% of total cost over the course of treatment, including co-pays, co-insurance, or deductibles for those who have commercial insurance or are paying cash.

Other

Drug / ASSAY COMPANY CO-PAY PROGRAM PATIENT ASSISTANCE DETAILS
Androgel (testosterone gel 1% & 1.62%) Used to treat adult males who have low or no testosterone. AbbVie, Inc. 800-441-4987 / androgel.com 800-222-6885 / abbviepaf.org; pparx.org Co-pay: Patient pays first $10, then covers up to $50 per month. Card available through provider or you can print the card online.
Egrifta
Injectable approved for treating HIV-related excess belly fat (lipohypertrophy).
EMD Serono 877-714-2947 / egrifta.com 877-714-2947 / egrifta.com Co-pay program covers up to $500 of your co-pay or co-insurance, per prescription. AXIS Center provides education and support; go to website or call 877-714-2947.
Fulyzaq
Anti-diarrheal approved for use in those with HIV/AIDS and on antiretroviral therapy.
Salix Pharmaceuticals None at press time. / fulyzaq.com None at press time. / fulyzaq.com No PAP or co-pay program at this time.
Check website for updates.
HLA-Aware
HLA-B*5701 test to determine if a person can start taking Ziagen, Epzicom, or Trizivir.
LabCorp/ViiV None. 800-533-1037 / viivhcdxresource.com No co-pay program, PAP only. Covers entire cost of test for insured/uninsured. Test must be ordered by provider. Contact local ViiV rep, order online, or call.
Procrit
Treats anemia due to zidovudine therapy.
Janssen None. 800-652-6227 / jjpaf.org No co-pay program, PAP only.
Radiesse
Injectable facial filler approved for use in people with HIV to treat facial fat loss (lipoatrophy).
Merz Aesthetics None. 866-862-1211 / radiesse-fl.com No co-pay program. PAP is sliding scale based on patient’s annual income up to $80,000; reimbursement goes directly to physician.
Sculptra
Injectable facial filler approved for use in people with HIV to treat facial fat loss (lipoatrophy).
Valeant Pharmaceuticals International None. 866-310-7551 / needymeds.org No co-pay program. PAP provides two kits and one follow up kit. Free for those with an annual income below $22,340, and then on a sliding scale up to $61,940.
Serostim
Injectable human growth hormone used for treating HIV-associated wasting in those on ART.
EMD Serono 877-714-2947 / serostim.com 877-714-2947 / serostim.com Co-pay program covers up to $200 of your co-pay or co-insurance per prescription discount, with a maximum of 12 prescription discounts per lifetime.
Testim (testosterone gel 1%)
For adult males with low or no testosterone.
Auxilium 866-740-8252 / testim.com 888-877-9192 Co-pay program covers up to $40 per month. Card available through provider or you can print the card online.
Trofile Assay
A test used for determining the tropism of a person’s HIV to identify if a CCR5 antagonist (such as Selzentry) would be effective.
Monogram Biosciences None. 877-436-6243 / monogramvirology.com Financial assistance to uninsured / underinsured; assists in prior authorization or if insurance reimbursement is denied. ViiV also has Tropism Access Program (TAP) for ADAP eligible; contact local ASO, ViiV rep, or state ADAP.

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