Copay assistance programs can be blessings for patients who cannot afford to pay for prescribed medications despite insurance coverage. Frequently, drug manufacturers are able to provide financial help directly to patients in need. To access manufacturer-sponsored programs, visit the brand website for the MS drug which you have been prescribed.
For patients who do not quality for manufacturer programs (perhaps due to insurance coverage through government programs such as Medicare), the following non-profit organizations offer additional help paying for medications. Some of these programs even offer financial help with insurance premiums and transportation costs to obtain treatment.
In general, to participate in these programs, the patient must have valid medical insurance that covers the prescribed medication, which in turn must be included on the program formulary; and the patient must meet annual household income criteria established by each program.
Update: Unfortunately some of these non-profit organizations may be underfunded and unable to accept new or renewing applicants. You may need to check back again after the New Year to learn if funds have reopened.
- Good Days, formerly known as the Chronic Disease Fund, provides direct financial assistance to MS patients prescribed a disease-modifying drug, excluding Novantrone. To participate with Good Days, patients must remain fully compliant with their medication.
- Good Days offers a Premium Assistance Program that helps patients find, and pay for, appropriate health insurance coverage.
- The Good Days Travel Concierge Program offers transportation services for pre-approved medical appointments to obtain treatment. If needed, the program may also arrange and cover lodging. Additional travel expenses, such as parking, fuel and meals, are covered.
- The Assistance Fund Copay Assistance Program offers financial support to individuals with MS who need help paying for their out-of-pocket expenses for approved specialty medications covered by insurance. Disease-modifying therapies for MS, excluding Novantrone, are included in the copay program.
- The Assistance Fund Health Insurance Premium Assistance Program offers financial assistance to individuals who need help paying for their monthly health insurance premiums.
- Patients are able to receive assistance through both programs simultaneously, as long as funding is available.
- The Healthwell Foundation provides financial assistance to individuals with MS, covered by Medicare, who need help paying for out-of-pocket costs related to approved disease-modifying therapies, excluding Novantrone. Patient household income must fall below 500 percent of the Federal Poverty Level (adjusted for household size and high cost of living areas). Maximum award is $6,000. Healthwell Foundation does not help with out-of-pocket expenses less than $25 per prescription refill.
- Healthwell Foundation also offers premium assistance to patients eligible for health insurance who cannot afford the insurance premiums.
- The Patient Access Network Foundation offers financial support to individuals with MS, covered by Medicare, who need help paying for out-of-pocket costs related to approved disease-modifying therapies, excluding Novantrone. Patient household income must fall below 500 percent of the Federal Poverty Level. Maximum award is $5,000; however, enrolled participants may apply for a second grant during their eligibility period if funding is available.
- Patient Services, Inc. (PSI) does not have a designated fund to cover expenses for individuals diagnosed with multiple sclerosis; however PSI does have a fund for patients diagnosed with pseudobulbar affect (PBA) which can be associated with MS. Patient Services, Inc. is available only to individuals with Medicare Part D coverage who cannot afford out-of-pocket expenses. Nuedexta (dextromethorphan hydrobromide and quinidine sulfate), covered by the program, is the first and only FDA-approved treatment for PBA.
- Caring Voices Coalition (CVC) offers non-financial assistance to individuals with MS. CVC insurance specialists can assist with denied claims appeals and help patients resolve insurance issues and explore sources of new or improved insurance coverage.
- The CVC Social Security disability program supports patients through the various stages of the Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) application process. Patient advocates, including skilled attorneys, coordinate supporting evidence, assess eligibility, submit claims for benefits and draft arguments.
- CVC’s patient education program helps to connect patients with public and private services that provide physical and emotional support to make life easier.
- The Patient Advocate Foundation (PAN) does not offer a designated copay assistance fund for individuals diagnosed with multiple sclerosis. PAN does offer vast amounts of information related to insurance and other financial matters. PAN case managers can assist patients in identifying other programs available within their state or locale that may be able to help.
Programs may periodically be unable to accept new or renewal applications based on lack of available funding. If you encounter a program which is temporarily closed to applications, try contacting the program again at a later date.
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Lisa Emrich is a patient advocate, accomplished speaker, author of the award-winning blog Brass and Ivory: Life with MS and RA, and founder of the Carnival of MS Bloggers. Lisa uses her experience to educate patients, raise disease awareness, encourage self-advocacy, and support patient-centered research. Lisa frequently works with non-profit organizations and has brought the patient voice to health care conferences and meetings worldwide. Follow Lisa on Facebook, Twitter, and Pinterest.