Patient Assistance and Drug Co-Pay Programs

In our current economic crisis and with the continued mounting costs associated with healthcare, drug co-pay programs may be a way to offer much-needed assistance to those who have insurance but are being adversely affected by increasing drug co-pays, health insurance premiums, and other rising costs associated with healthcare.

Most, if not all, HIV 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. Individuals and care providers can contact the manufacturer directly to see if a patient is eligible for a specific patient assistance program (PAP).

Several companies have also recently instituted co-pay assistance programs. 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, ADAP, Medicare, and Medicaid are not accepted), 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 eligible they can bring the co-pay card to their pharmacy when filling a prescription and the pharmacy is then reimbursed for the amount covered.

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 on HIV drug pricing issues and to help control costs, helping to ensure access to life-saving medications for recipients of state AIDS Drug Assistance Programs (ADAPs), Medicare, and Medicaid, as well as for those who are privately insured, underinsured and uninsured.

Nowadays many health insurers contract with Prescription Benefits Managers (PBMs) to reduce healthcare costs through the use of mail order pharmacies. Unfortunately many of the most widely-used mail order pharmacies in the U.S. do not honor co-pay cards, simply because their systems are not setup to handle them or they don't have the software to process this type of reimbursement. This is an important issue as more and more patients are required by their company's healthcare plan to acquire their medications through a mail-order pharmacy, and one that the Fair Pricing Coalition is currently working to address.

There may be medications in addition to HIV drugs that individuals must take, such as those needed to control other conditions including high cholesterol or diabetes. To find patient assistance or drug co-pay programs for these and other types of drugs, visit www.needymeds.com.

Together Rx is a prescription savings 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 patients can enroll online at www.TogetherRxAccess.com.

Below is a brief description of currently available HIV co-pay programs. For more information call the Project Inform Hotline at 1-800-822-7422, or visit www.positivelyaware.com and www.aidsmeds.com.

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 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. Visit www.kaletra.com for more information. Norvir is currently not part of this program.

Bristol-Myers Squibb: Reyataz and Sustiva Co-pay Benefit Program -- covers Reyataz and Sustiva; for high co-pays only. Patient responsible for first $50 plus any amount over $250. If healthcare provider does not have card, patients can call 1-888-281-8981 or visit http://www.bristol-myers.com/static/patient_assistance/data/programs.html.

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 healthcare provider does not have card, patients can call toll-free 1-866-784-3431 and one will be mailed to them.

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 healthcare provider does not have the card, patients can call toll-free 1-888-358-0398 and one will be mailed to them.

GlaxoSmithKline: MySupportCard -- This is 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. All GSK HIV drugs (Combivir, Epivir, Epzicom, Lexiva, Retrovir, Trizivir, and Ziagen) are covered. Patients can get the card from their provider or print out the card online at www.mysupportcard.com.

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. Patients can visit www.prezista.com/prezista/patient_assistance.html or call toll-free 1-866-961-7169.

Merck does not have a specific insurance co-pay assistance program, however they do have a patient assistance program for Isentress and Crixivan called "Support."  Those needing co-pay assistance for Crixivan or Isentress should use the "Support" program. Call 1-800-850-3430, or visit www.isentress.com, click on the site map, and then click "Support."

Pfizer does not offer co-pay assistance for HIV medications, however, they do provide reimbursement assistance, appeals assistance, and patient assistance for Selzentry, Viracept and Rescriptor, and also offer information on obtaining assistance with tropism testing. Call the Pfizer RSVP program at 1-888-327-RSVP (7787) M-F, 9:00 am - 8:00 pm Eastern Time; fax 1-888-773-0121, or write to Pfizer RSVP, PO Box 220574, Charlotte, NC. 28222-0574. For assistance with all other Pfizer medicines, call Pfizer Helpful Answers (PHA) at 1-866-706-2400, or visit www.pfizerhelpfulanswers.com.

Jeff Berry is Director of Publications for Test Positive Aware Network and editor of Positively Aware magazine, co-chair of the AIDS Treatment Activists Coalition (ATAC) Drug Development Committee (DDC), and a member of the Fair Pricing Coalition. Adapted with permission from the 13th Annual Positively Aware HIV Drug Guide, March/April 2009.

Taken from the 13th Annual Positively Aware HIV Drug Guide, March/April 2009 issue.

To view table of contents for The 13th Annual HIV Drug Guide, click here.

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