Financial Assistance for Your Multiple Sclerosis Medications

Lisa Emrich Health Guide June 23, 2009
  • When it comes to finding financial assistance in paying for expensive medications, the process is not often an easy one.  Many of the pharmaceutical companies which produce drugs specific for the treatment of multiple sclerosis make available financial assistance to patients in need.  This is for the benefit of the patient but also for the drug company.  Face it, they wish for you to be able to continue to use their medication and not move to the competition which might have better assistance available.

     

    Often each company will run their own program or make contributions to independent foundations which handle the administration of “free medication” or copayment assistance.  Then, don’t forget about sources of lower cost generic drugs and/or drug coupon programs.

     

    NeedyMeds and the National Multiple Sclerosis Society have collaborated to create an Multiple Sclerosis Resource Page: http://www.needymeds.org/resourcepages/ms.shtml

     

    This post is long, so keep scrolling through until you find your drug and/or the appropriate assistance program for you!  Also, if you need help figuring out where you stand in relation to the Federal Poverty Level (FPL), use this page from the U.S. Department of Health & Human Services Web site, which has a useful table: http://aspe.hhs.gov/poverty/09poverty.shtml

     

    1. ASSISTANCE FROM THE MANUFACTURER

     

    Avonex Access Program
    The patient must be uninsured or underinsured and meet income guidelines that are not disclosed. The patient must also have MS. The patient must also be a US resident. Patients will be referred to a financial counselor to determine assistance. Those with Medicare Part D may eligible. Decisions made on a case by case basis. There is no application. Some income documentation may be requested.

     

    Avonex Access Program

    5000 Davis Drive, P.O. Box 13919, Research Triangle Park, Morrisville, NC 27709
    Phone: (800) 456-2255, Opt 2 or (617) 914-6524
    Fax: (877) 301-5140
    Program website: http://www.avonex.com/msavProject/avonex.portal

     

     

    Betaseron Patient Assistance Program
    The patient must meet insurance and financial guidelines that are not disclosed. meet income guidelines that are not disclosed. The patient must also have MS. The patient must also be a US resident. The support program is very detailed, including registered nurse counselors who are available 24 hours a day, seven days a week. They also provide training if needed.

     

    Betaseron Patient Assistance Program

    P.O. Box 221349, Charlotte, NC 28222-1349
    Phone: (877) 836-5724
    Fax: (877) 744-5615
    Application: http://www.needymeds.org/papforms/betase0112.pdf

     

    Access Specialists, a part of the BETAPLUS™ MS support program, are available to answer your questions and work directly with your insurance or managed care company to help determine your pharmacy benefits, seek prior authorization for your medication, and handle appeals and other coverage issues.

     

    For qualified persons, Betaseron is available for no more than $50 per month copay. Unlike offers from other therapies, this offer is available regardless of how long you've been on therapy.  Some restrictions apply. Patients enrolled in any type of government insurance are not eligible. Void where prohibited by law, taxed, or restricted

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    A new BETAPLUS™ program will cover the full amount of one month's prescription copay up to $500.  Must be on Betaseron for 11 consecutive months and provide pharmacy copay receipts in order to receive your payment. See Terms and Conditions. Bayer reserves the right to rescind, revoke, or amend this offer at anytime without notice.

     

    BETAPLUS™ Support Services
    Phone: (800) 788-1467
    Program website: http://www.betaseron.com/patients/about_betaseron/affording_betaseron.jsp
    Program brochure: http://www.betaseron.com/patients/pdfs/11th%20Copay%20Refund%20Brochure.pdf

     

     

    Copaxone® Patient Assistance Program

    The patient must be uninsured or underinsured and meet income guidelines that are not disclosed. Medical diagnosis necessary for this program is not specified. The patient must also be a US resident or legal alien. There are two programs: one for people with no insurance or who are underinsured (which is run by NORD, the National Organizations for Rare Disorders) and one for people who need assistance with the co-payments through a chronic disease fund. This program is dependent on funding. If there is no funding available, then the patient is put on a list and contacted once funding is available to assist.

     

    Shared Solutions
    901 East 104th St., Suite 900. Kansas City, MO 64131
    Phone: (800) 887-8100
    Program website: http://www.copaxone.com/supportServices/default.aspx
    Program website: http://www.rarediseases.org/programs/medication

     

    ***Also note that Shared Solutions has recently implemented a copay program similar to the one below offered for Rebif.  However, it is not posted anywhere on the Copaxone website.  Shame on you Teva and Shared Solutions.

     

    Off the top of my head, I believe that they will pay up to $50 for anyone’s monthly copay regardless of financial status.

     

     

    Rebif Assistance Program
    Through MS Lifelines® Access Made Simple, you may be eligible to get Rebif at no cost, or for no more than $50 per month, for up to 1 year of treatment.  If you are currently uninsured, are insured with no drug benefit, or have exhausted your drug coverage and you meet the other eligibility requirements for this program, you will receive Rebif at no cost. If you have a high co-pay (over $50), you may be eligible to receive Rebif for up to 1 year for no more than $50 a month.

     

    Regardless of financial status, the MS LifeLines Access Made Simple program is open to US resident with a relapsing form of MS, and who have been newly prescribed Rebif therapy or are restarting therapy after having previously discontinued Rebif for at least 90 days.  Some limitations are required by law. People residing in certain states, as well as those covered by federal and state programs, may not be eligible for assistance.

     

    MS Lifelines® Access Made Simple
    Phone: (877) 447-3243 option 4
    Fax: (866) 227-3243
    Program website: http://www.mslifelines.com/rebif/affordableaccess/access-made-simple.jsp

     

     

    Tysabri Patient Assistance Program
    Biogen-Idec financial assistance services for TYSABRI patients include: providing co-payment assistance if you are eligible and insured; helping identify other sources of financial assistance; and providing free drug to eligible TYSABRI patients  The patient must be uninsured or underinsured and meet income and other eligibility guidelines that are not disclosed. The patient must also have MS and be a US resident.  Those with Medicare Part D may eligible. Decisions made on a case by case basis.

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    Phone: (888) 489-7227 or (800) 456-2255
    Program website: http://www.tysabri.com/tysbProject/tysb.portal/_baseurl/threeColLayout/SCSRepository/en_US/tysb/home/treatment-with-tysabri/tysabri-patient-services.xml

     

     

    Novantrone Patient Assistance Program
    The patient must not have any private nor public insurance and meet income guidelines that are not disclosed. Medical diagnosis necessary for this program is not specified. The patient must also be a US resident.

     

    Novantrone Patient Assistance Program

    1 Technology Place, Rockland, MA 02370
    Phone: (877) 447-3243
    Fax: (866) 227-3243
    Program website: http://www.mslifelines.com/rebif/affordableaccess/access-made-simple.jsp

     

     

    Acthar® Gel Patient Assistance Program
    The patient must have no insurance and be financially unable to afford the medication. The patient is given assistance from 25%-100% for one year. A negative decision can be appealed. The patient must also be a US citizen being treated by a US doctor.

     

    Acthar Gel Patient Assistance Program

    C/O NORD, P.O. Box 1968, Danbury, CT 06813-1968
    Phone: (888) 435-2284
    Fax: (203) 798-2289
    Program website: http://www.rarediseases.org/programs/medication

     

     

    2. ASSISTANCE FROM COPAYMENT FOUNDATIONS

     

    A copayment is the amount an insured patient must pay for a prescription drug or an office visit at the time of service.  It is part of the cost-sharing arrangement with the health insurance company and varies depending upon the specifics of coverage.  Patients who have private insurance coverage or a Medicare Part D plan but still can’t afford the copays or deductibles for the expensive medications they need are considered UNDERINSURED.

     

    Since 2003, a number of independent, charitable organizations have been established to assist the underinsured patient in meeting this specific financial need.  The drug companies make contributions to each organization which then independently administer the assistance to medically and financially qualified patients according to their own criteria and resources.

     

    Each of the following non-profit organizations maintain segregated disease funds, including ones for MULTIPLE SCLEROSIS, from which awards are made.  When the resources of a particular fund become too low, applications will not be accepted until sufficient funds become available.  This means that you may need to bounce back-and-forth between organizations looking for assistance and may even have to wait until a program opens up to new or renewing patients.

     

     

    The Chronic Disease Fund (CDF)
    The Chronic Disease Fund supports patients with chronic disease, cancers or life-altering conditions and provides financial assistance for FDA-approved specialty therapeutics used to treat those diseases. We maintain separate Disease Trusts with segregated funds, and the Fund exclusively defines the disease states and the specialty therapeutics covered using our proprietary guidelines.  Financial eligibility guidelines are not disclosed.

    Program currently includes Avonex, Betaseron, Copaxone, Rebif, and Tysabri.

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    Chronic Disease Fund

    6900 N. Dallas Parkway, Suite 200, Plano, TX 75024

    Phone: (877) 968-7233 or (972) 608-7141

    Email: info@cdfund.org
    Program website: http://www.cdfund.org/

     

     

    Patient Access Network Foundation (PANF)
    The Patient Access Network Foundation helps to pay for medical expenses including: medications, co-payments, insurance premiums and other out-of-pocket health care costs.  Patient should be insured and insurance must cover the medication for which patient seeks assistance.  The medication must fight the disease directly.  Patient must be a legal U.S. resident.  Patient’s family income must fall below 300% Federal Poverty Level.  Maximum Award: $4000

     

    Program currently includes Avonex, Betaseron, Copaxone, Rebif, and Tysabri.

     

    Patient Access Network Foundation

    P.O. Box 221858, Charlotte, NC 28222

    Phone: (866) 316-PANF or (866) 316-7263

    Email: contact@patientaccessnetwork.org
    Program website: http://www.panfoundation.org/

     

     

    NORD MS Premium / Co-Payment Assistance Program
    This program will provide up to $5400 per year to cover the costs of co-pays for approved medications used to treat Multiple Sclerosis. Contact the program directly or visit the program website for a list of approved medications.

     

    55 Kenosia Ave, P.O. Box 1968, Danbury, CT 06813
    Phone: (800) 634-7207 or (203) 744-0100
    Fax: (203) 798-2291
    Program website: http://www.rarediseases.org/programs/medication

     

     

    NORD MS Related Acute Exacerbation Premium / Co-Payment Assistance Program
    This program will provide assistance for treatment of MS exacerbation.  No further information is available.

    55 Kenosia Ave, P.O. Box 1968, Danbury, CT 06813
    Phone: (888) 435-2284
    Program website: http://www.rarediseases.org/programs/medication

     

     

    HealthWell Foundation
    The HealthWell Foundation®  provides financial assistance to eligible patients to cover certain out-of-pocket health care costs, including prescription drug coinsurance, copayments, and deductibles, or health insurance premiums and other select out-of-pocket health care costs.  Patient should be insured and insurance must cover the medication for which patient seeks assistance.  The medication must fight the disease directly and be included specifically within the select disease fund.  Patient must be a legal U.S. resident.  Patient’s family income must be at or below 400% Federal Poverty Level.

     

    The HealthWell Foundation®  currently does NOT have a fund for multiple sclerosis.

     

    The HealthWell Foundation®

    P.O. Box 4133, Gaithersburg, MD 20878
    Phone: (800) 675-8416
    Fax: (800) 282-7692
    Email: info@healthwellfoundation.org
    Program website: http://www.healthwellfoundation.org/index.aspx

     

     

    Patient Advocate Foundation (PAF) Co-Pay Relief Program
    The Patient Advocate Foundation (PAF) Co-Pay Relief Program currently provides direct financial support to insured patients, including Medicare Part D beneficiaries, who must financially and medically qualify to access pharmaceutical co-payment assistance.  Patient should be insured and insurance must cover the medication for which patient seeks assistance.   The program offers personal service to all patients through the use of call counselors; personally guiding patients through the enrollment process.  The program does not offer insurance premium assistance at this time.

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    The Co-Pay Relief currently does NOT have a fund for multiple sclerosis.

     

    Co-Pay Relief

    700 Thimble Shoals Boulevard, Newport News, VA 23606

    Phone: (866) 512-3861 or (757) 952-0118
    Fax: 757-952-0119
    Program website: http://www.copays.org/

     

     

    Patient Services Incorporated (PSI)
    Patient Services Incorporated is a health insurance premium and copayment foundation which assists people who live with certain chronic illnesses or conditions locate suitable health insurance coverage and access ways to satisfy expensive co-payments.  PSI provides assistance with the cost of health insurance premiums associated with COBRAs, State High-Risk Pools, Open enrollment, Guaranteed Issue policies, HIPAA conversion policies; and prescriptions co-payments associated with private insurance as well as with Medicare Parts B and D.

     

    **A client service representative from PSI helped me to find financial assistance from within my local county government’s social services program after I had been turned down by many other programs.  Definitely an advocate for the patient, in my opinion.

     

    Patient Services Incorporated currently does NOT have a fund for multiple sclerosis.

     

    Patient Services Incorporated

    P.O. Box 1602, Midlothian, VA  23113
    Phone: (800) 366-7741
    Fax: (804) 744-5407
    Email: uneedpsi@uneedpsi.org
    Program website: http://www.uneedpsi.org/CMS400Min/index.aspx

     

     

    3. SOURCES OF LOWER COST GENERIC DRUGS

     

    Rx Outreach
    Rx Outreach is managed by Express Scripts Specialty Distribution Services, Inc. (ESSDS), a fully-licensed mail order pharmacy that is committed to making the use of prescription drugs safer and more affordable. Rx Outreach is not a prescription insurance program nor an Internet pharmacy.  The program offers prescription medicines to uninsured individuals and families, as well as those who have limited prescription drug coverage.  Patient’s family income must be below 300% Federal Poverty Level.

     

    The cost to fill a prescription depends on the medication and the quantity you need. Prices can be found on the Rx Outreach drug list.  The price listed is for any dose or strength. There is no membership fee required to use Rx Outreach.

     

    **This is my favorite low-cost program available for generic medications.

    Rx Outreach

    Express Scripts Specialty Distribution Services, Inc., P.O. Box 66536, St. Louis, MO 63166-6536
    Phone: (800) 769-3880
    Email: rxoutreach@express-scripts.com
    Program website: http://rxoutreach.com/

     

    Please don’t forget about the generic drug programs available at:

     

    Walmart Pharmacy: http://www.walmart.com/pharmacy

    Target Pharmacy: http://www.target.com/

     

     

    Lisa Emrich is author of the blog Brass and Ivory: Life with MS and RA and founder of the Carnival of MS Bloggers.