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:

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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.