costs and insurance

Financial Assistance for Your Rheumatoid Arthritis Medications

Lisa Emrich Health Guide June 22, 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 that produce drugs specifically for the treatment of rheumatoid arthritis make financial assistance available to patients in need.  This benefits the patient and the drug company.  Face it, they want you 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 that 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.

     

    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

    Adalimumab (Humira)
    The HUMIRA Protection Plan helps patients access HUMIRA.  If you are unemployed and uninsured, you may be able to get HUMIRA at no cost to you through the Abbott Patient Assistance Foundation.  If you are covered by Medicare Part D, you may be able to get help from an independent co-pay foundation.

     

    If you are employed with prescription coverage, you can reduce your co-pay to $5 per month.  However, this copay assistance program is not valid for prescriptions reimbursed under Medicare, Medicaid, or similar federal or state programs or private insurance in the Commonwealth of Massachusetts.  Monthly co-pay assistance amounts are subject to predetermined limits.

     

    Phone: (888) HUMIRA3 or (888) 486-4723 for reimbursement assistance
    Program website: http://www.humira.com/Global/FinancialHelp/Default.aspx

     

    The Abbott Patient Assistance Foundation is designed to help financially disadvantaged individuals receive a limited supply of Abbott pharmaceutical products at no cost.  To be eligible for this program, patients must not have prescription drug coverage for the requested medication through an employer other third party payer, Medicaid or any other state or federally-funded program, and must be financially disadvantaged based upon current Federal Poverty Guidelines adjusted for household size.  Patients with prescription drug coverage, including enrollment in a Medicare Part D Prescription Drug Plan, who have difficulty accessing their Abbott medications may be eligible for assistance by obtaining a Pharmaceutical Assistance Program exception based on health-related expenditures and household income.

     

    Abbott Patient Assistance Foundation - HUMIRA Patient Assistance Program

    P.O. Box 789, San Bruno, CA 94066
    Phone: (800) 222-6885 for uninsured or underinsured assistance
    Fax: (866) 250-2803
    Application: http://www.needymeds.org/papforms/abbhum0323.pdf

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    Etanercept (Enbrel)   
    The ENBREL Support™ Copay Program lowers costs for eligible patients.  The program may offer 6 months at no copay cost to you and $10 or less copay per month thereafter.  This program is not open to uninsured patients or for patients whose prescriptions are reimbursed under Medicare, Medicaid, or similar federal or state programs or private insurance in the Commonwealth of Massachusetts.

     

    Program provides up to $750 of assistance per patient per month for months 1-12.  Patient is responsible for costs above these amounts.  Financial support is available to you each time you fill your ENBREL prescription and you may renew your participation in the ENBREL Support copay program every 12 months.

     

    Phone: (888) 4-ENBREL or (888) 436-2735 for reimbursement assistance
    Program website: http://enbrelsupport.com/

     

    If you have no insurance coverage or are underinsured, you may be referred to the ENcourage Foundation Patient Assistance Program, a nonprofit foundation support by Amgen and Wyeth.  If you are insured but still need more financial assistance, you may be referred to an independent foundation.

     

    ENcourage Foundation, P.O. Box 4133, Gaithersburg, MD 20879-7808
    Phone: (800) 282-7752 for uninsured or underinsured assistance
    Fax: (888) 508-8083
    Application: http://www.needymeds.org/papforms/encour0284.pdf

     

     

    Infliximab (Remicade), Tramadol (Ultram, Ultram-ER)
    Tramadol with acetaminophen (Ultracet)
    Janssen Ortho Patient Assistance Foundation Program

    P.O. Box 221857, Charlotte, NC 28222-1857
    Phone: (800) 652-6227
    Fax: (888) 526-5168
    Application: http://www.needymeds.org/papforms/johnso0996.pdf

     

     

    Infliximab (Remicade)
    Phone: (888) ACCESS-1 or (888) 222-3771 for reimbursement assistance
    Or call (866) 489-5957 and select option 1

    Program website: http://www.remicade.com (select “getting support”)
    Program website: http://www.remicade.com/remicade/global/index.html

     

     

    Rituximab (Rituxan)
    Rituxan Access Solutions
    Phone: (866) 681-3261 for reimbursement assistance.
    Phone: (866) 681-3320 for uninsured or underinsured assistance
    Program website: http://www.RituxanAccessSolutions.com/
    Patient Enrollment Form: http://www.needymeds.org/papforms/genave0079.pdf
    Patient Authorization Form: http://www.needymeds.org/papforms/genave0079.pdf
    Program website: http://www.genentechaccesssolutions.com/rituxanRA/patient/index.jsp
    Fax: (866) 681-3288

     

    Anakinra (Kineret)
    The Kineret Reimbursement Support Program helps to verify insurance coverage and provides temporary product assistance to financially needy patients who meet predetermined eligibility criteria.  To receive free product, the prescriber and patient must complete a Kineret Patient Assistance Program Application.

     

    The Kineret® and Kepivance® Patient Assistance Program

    P.O. Box 13185, La Jolla, CA 92039-3185
    Phone: (866) 547-0644 for reimbursement assistance
    Fax: (866) 549-7219
    Application: http://www.kineretrx.com/pdf/Kineret_PAP_Application_Form.pdf
    Program website: http://www.kineretrx.com/patient


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    Abatacept (Orencia)
    The ORENCIA Promise Program is a copay program for new ORENCIA patients with private health insurance that covers medication costs for ORENCIA.  To be eligible, you must be new to treatment with ORENCIA (are no currently taking ORENCIA or have not taken ORENCIA in the past 6 months).  This program is not open to uninsured patients or for patients whose prescriptions are reimbursed under Medicare, Medicaid, or similar federal or state programs or private insurance in the Commonwealth of Massachusetts.

    “The ORENCIA Program Program pays the full copay for ORENCIA for the first 6 months of therapy (8 infusions).  Plus, if you are not satisfied after 6 months, we’ll pay your first copay of another RA medicine, up to $500.”

     

    Phone: (800) 675-8416 for copayment assistance
    Phone: (866) 268-4514 for reimbursement assistance and uninsured or underinsured assistance
    Program website: https://www.theorenciapromiseprogram.com/orencia/registration.jsp

     

    Bristol-Myers Squibb Patient Assistance Foundation, Inc. (ORENCIA®)

     

    To qualify, you must not have prescription drug coverage or receive any benefits that help you pay for prescription drugs, such as Medicaid, Medicare Part D, state sponsored prescription drug programs, employee, military, retirement, or pension program drug coverage.  Please note that pharmacy discount cards or drug company patient assistance programs are not considered to be prescription drug coverage and if you participate in these programs you still may qualify for assistance.

     

    Bristol-Myers Squibb Patient Assistance Foundation, Inc. (ORENCIA®)

    P.O. Box 991, Somerville, NJ 08876

    Phone: (800) 736-0003 Option 4
    Fax: (866) 694-2545
    Application: http://www.needymeds.org/papforms/brisor1073.pdf
    Program website: http://www.bmspaf.org/program5.html

     

     

    Leflunomide (Arava)
    Sanofi-Aventis Patient Assistance Program
    Application: http://www.needymeds.org/papforms/sanofi0150.pdf

     

    The patient cannot have prescription insurance, be ineligible for any federal or state programs and have an income at or below 250% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. The patient must also be a US resident. Patients with Medicare Part D are not eligible, however, if they have Part D and are still having problems affording the medication, they may apply. Sanofi Aventis may help patients in the donut hole. They will initially deny patient but submit an appeal and state that patient is in the DH and has no coverage.

     

    Mycophenolate mofetil (CellCept)
    Roche Reimbursement and Patient Assistance Program
    Program website: http://www.cellceptforliving.com/

     

    The patient must meet insurance guidelines that are not disclosed and have an income at or below 300% of the Federal Poverty Level.

       

     

    Cyclosporine (Neoral)
    Novartis Patient Assistance Program for Specialty Medicines
    Program website: http://www.pharma.us.novartis.com/products/name/neoral.jsp

     

    Minocycline (Minocin, Dynacin)

  • Triax Pharmaceuticals Patient Assistance Program
    Application: http://www.needymeds.org/papforms/triaxp1081.pdf

     

     

    Mefenamic acid (Ponstel)
    Sciele Patient Assistance Program

    Application: http://www.needymeds.org/papforms/sciele0194.pdf

     

    Indomethacin (Indocin, Indocin SR)
    Ovation Pharmaceuticals Patient Assistance Program

     

    Chlorambucil (Leukeran)
    Committment to Access http://www.commitmenttoaccess.com/

    The patient must not have any private nor public insurance and have an income at or below $52000 for an individual, $70000 for a family of 2, $88,000 for a family of three, $106,000 for a family of four, for each addtl person add $18000 to limits. Medical diagnosis necessary for this program is not specified. The patient must live in the US and utilize the US healthcare system. Medicare Part D enrollees can enroll with proof that they have spent at least $600 on prescription medications through the Medicare Part D prescription Drug Plan in the current calendar year. GlaxoSmithKline requests that an 'Advocate' be the contact person for the patient throughout the entire process.



    GSK-Access for medicare only http://www.gsk-access.com/
    Application form http://www.gsk-access.com/enrollment/enrollment_forms.html

    The patient must have Medicare Part D, and have an income at or below 250% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. US residency requirements not specified The patient must also have spent $600 dollars on medications through the Medicare Part D plan
    Application Process    

    The patient is sent a pharmacy card. The pharmacy card is good for one year. Every year a new application is needed.

     

     

    Oxycodone (OxyContin, Roxicodone, OxyFAST, OxyIR (liquid))
    Purdue Frederick Patient Assistance Program

     

    The patient must have no insurance and have an income at or below 200% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. The patient must also be a US resident.  There is also a co-pay of $25 for each prescription that must be sent in as a money order. Any patient who is denied assistance can appeal the decision by resending the application with a letter of explanation. This includes patients with insurance, patients in a gap, people who are eligible for Medicare Part D but did not enroll and patients who are in the Medicare Part D Donut Hole.

     

     

    Pfizer Connection to Care

    Program website: http://www.pfizerhelpfulanswers.com/pages/misc/default.aspx

    Includes:
    Diclofenac sodium with misoprostol (Arthrotec)
    Sulfasalazine (Azulfidine, Azulfidine EN-Tabs)
    Celecoxib (Celebrex)
    Hydrocortisone (Cortef, Hydrocortone)
    Oxaprozin (Daypro)
    Piroxicam (Feldene)
    Methylprednisolone (Medrol)

     

     

    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.

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    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 RHEUMATOID ARTHRITIS, 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 Enbrel and Humira for the treatment of Rheumatoid Arthritis.

     

    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 Ansaid, Arava, Azulfidine entabs, Celebrex, Cataflam, CellCept, Clinoril, Cytoxan, Enbrel, Humira, Imuran, Indocin, Kineret, Leukeran, Lodine, Methotrexate, Minocin, Mobic, Naprosyn, Neoral, Orencia, Plaquenil, Prednisone, Remicade, Rheumatrex, Rituxan, Trexall, Voltaren.

     

    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/

     

    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.

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    Program currently includes Enbrel, Humira, Kineret, Orencia, Remicade, Rituxan, Arava, CellCept, Cytoxan, Imuran, Leukeran, Neoral, Decadron, Deltasone, Medrol, Pediapred, Rheumatrex, Solu-Medrol, Trexall.

     

    **Warning: Not every drug included on the program’s list is approved for use with every disease condition.  For instance, although Rheumatrex is listed, it is not available to RA patients but only Breast Cancer patients.  Check with program for current policies.

    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.

     

    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

    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.

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    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/

     

    Program currently includes the following medications used for Rheumatoid Arthritis:
    Methotrexate (Rheumatrex, Trexall): $25 for 90-day supply
    Hydroxychloroquine (Plaquenil): $25 for 90-day supply or $45 for 180-day
    Minocycline (Minocin, Dynacin): $45 for 90-day supply or $85 for 180-day
    Piroxicam (Feldene): $15 for 90-day supply
    Meloxicam (Mobic): $20 for 90-day supply
    Ibuprofen (Motrin): $20 for 90-day supply
    Naproxen (Naprosyn, Naprelan): $20 for 90-day supply
    Naproxen sodium (Anaprox): $25 for 90-day supply
    Etodolac (Lodine, Lodine XL): $30 for 90-day supply
    Nabumetone (Relafen): $35 for 90-day supply
    Tramadol (Ultram, Ultram-ER): $35 for 90-day supply
    Diclofenac sodium (Voltaren): $25 for 90-day supply
    Diclofenac sodium (Voltaren XR): $40 for 90-day supply
    Oxaprozin (Daypro): $50 for 90-day supply

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

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


    4. DRUG COUPON PROGRAMS

    Together RX Access Program
    The Together Rx Access® Card is a discount-savings card available to individuals with no prescription drug coverage of any kind and who are not eligible for Medicare.  Patient must be a legal resident of the United States or Puerto Rico. Patient’s family income must be below 400% Federal Poverty Level.

     

    Most cardholders save 25%–40%* on brand-name prescription medicines and products.  Savings are available on generic drugs as well.  No maximum usage limit, no hidden fees, and no monthly charge.  Please see The Complete Drug List for an up-to-date listing of the brand-name prescription medicines and products included in the Program.

     

    Phone: (800) 444-4106
    Program website: http://www.togetherrxaccess.com/Tx/jsp/about_eligibility.jsp

     

    Program currently includes the following medications used for Rheumatoid Arthritis:
    Flurbiprofen (Ansaid)
    Leflunomide (Arava)
    Diclofenac sodium with misoprostol (Arthrotec)
    Morphine sulfate (Avinza , Oramorph SR)
    Sulfasalazine (Azulfidine, Azulfidine EN-Tabs)
    Celecoxib (Celebrex)
    Hydrocortisone (Cortef, Hydrocortone)
    Oxaprozin (Daypro)
    Piroxicam (Feldene)
    Chlorambucil (Leukeran)
    Methylprednisolone (Medrol)
    Tramadol (Ultram, Ultram-ER)
    Tramadol with acetaminophen (Ultracet)
    Acetaminophen with codeine (Phenaphen with Codeine, Tylenol with Codeine #3)

     

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

Live Bold, Live Now Living With Rheumatoid Arthritis