Patient Assistance

When my doctor first suggested trying something stronger than the three DMARDs I was taking, one of my hesitations was the cost.  Biologics are expen$ive.  Fortunately, there are financial assistance programs to reduce patient’s out-of-pocket costs.

A year ago, after checking the details of the patient-assistance programs, I selected Enbrel (read here and here, then here and here).  Their website made it clear that given my situation, I wouldn’t have to pay more than $10 every four-weeks.  Humira, on the other hand, required me to release my family’s income information before giving any indication as to whether or not I qualified for their program (something I didn’t really want to do), and it wasn’t clear what the patient’s actual costs would be.

Recently I switched from Enbrel to Humira, and was happy to discover that they’ve changed their assistance criteria (or at least changed their presentation of it).  Maybe some people are still required to provide financial data, but I didn’t have to do that.  It turns out that a patient’s costs under Humira’s assistance program can be less than the cost of Enbrel.

 

The catch is that the Humira help desk was adamant that (despite what the literature says) this is for twelve fills, not twelve months.  I don’t know if that means the person didn’t know what he was talking about, or if it means patients pay the full amount for that final prescription fill of the year.*

If you’re on Humira, make sure your pharmacy knows that the patient assistance program picks up the co-pay on one of your other DMARDs, too.  I expected $5 each, and was thrilled to learn that it was $5 total.

Patient Assistance Programs for Biologic Medications:

______________________
Monthly medications get twelve fills per year – unless your insurance only allows 30 days worth of meds per month, in which case twelve fills leaves you short five days of meds over the course of a year.

Twenty-eight day meds need thirteen fills per year.  28 days equal four weeks, and as any five-year-old card shark can tell you, 52/4=13 whether you’re talking about number of cards per suit, or number of four-week periods in a year’s worth of prescriptions medications.


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8 thoughts on “Patient Assistance

  1. Good info to have, Socks, and thanks for posting it. I have a question, though: For how long does the pharma co. reduce what you pay for their drug? Is it for just those twelve “fills”, and after that, you’re on your own paying full price ever after? Or can you re-apply after twelve fills for as long as you’re taking the med? Put more simply (it’s early and my brain isn’t all there yet): Is the assistance strictly temporary?

    • Both Humira and Enbrel allow annual renewal. I think the other programs do, too. For you with the VA, it might be different. The rules are different for people with government-related coverage.

      It looks like assistance on the IV meds is just for the medication, not for the infusion costs, another thing to be aware of.

  2. VERY helpful info Warm Socks! Do they provide different assistance or no assistance for those on medicare or other govt assistance? I imagin they don’t since they can’t recoup the amount from them that they could from private/commercial assistance. I didn’t see a link for folks like that but didn’t hunt around. Haven’t read the privacy policy yet either. Wonder who all and what info they might share on that. But definitely worth looking into. Thank you so much for gathering all those links into one useful spot!

    • I don’t know about the other assistance options, but will see what I can find out.

      The way the Enbrel & Humira programs work, the pharmacy runs everything through my insurance. After insurance covers their portion and says what my co-pay should be, the pharmacy runs the patient assistance program as secondary insurance. The assistance program picks up part of my co-payment after primary insurance has paid its part.

      There’s a limit to how much they’ll cover over the course of a year (a few thousand dollars), so if someone has a very high deductible, they could potentially use it all up.

  3. Wow – this is great, thank you for sharing. I wish I’d known this last year when I was on Enbrel and had 80% drug coverage and was paying over $300 per month out of pocket.

    • :O Your rheumatologist didn’t give you a patient-assistance card? That’s a whole lot of money! I didn’t have to ask; my doctor gave it to me before she wrote my prescription.

      One possibility: Are you in Massachusetts? There are weird laws in Mass greatly restricting what pharmaceutical companies can do.

      I hope your meds are more affordable now!

  4. I was diagnosed with RA 12 years ago and have been on almost every medication out there…Enbrel, Humira, Cimzia, Remicade, and a few others. The most frustrating part is that there are no assistance programs to help with the cost of the infusion. The Remicade worked best of all of the meds I have been on, but I had an allergic reaction to it, and could no longer afford the $343.00 a month it cost for the infusion. I receive Disability in the of 845.00 a month, so I cant very well pay over a third of my income to medical expenses. How sad is it that people are denied medical treatments that are potentially life altering because of financial restrictions??

    • It looks like Remicade’s patient-assistance program is for the cost of the medication, not the associated fees for the infusion, which makes sense.

      I think most hospitals have financial assistance programs to help out people in situations such as you describe. Disability might throw a wrench into things, though, because that would also mean medicaid, right? All the rules change when it’s the government paying for stuff. Still, it wouldn’t hurt to contact the billing office and ask.

      As for the allergic reaction, ask on Arthritis Foundation’s support forum. I think many people have an allergic reaction to Remicade, but are able to take large quantities of benadryl and still get their infusion. It depends on the type/severity of reaction. Just a though. Good luck!

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