Patient Assistance and Co-Pay Programs for Viral Hepatitis Drugs
Introduction
Do you lack health insurance but make too much money to qualify for government assistance? Are your prescription co-payments so high that you can’t afford other basic necessities? Help may be available from pharmaceutical companies in the form of patient assistance programs (PAPs) and co-pay programs.
Over the past two years, the Fair Pricing Coalition (FPC) has been working closely with the pharmaceutical industry to streamline access to co-pay programs and PAPs for people living with viral hepatitis. The FPC has negotiated co-pay programs with virtually every major hepatitis drug manufacturer. Following is a list of co-pay and patient assistance programs for hepatitis B and C, and contact information for these programs. This is a living document that will be updated as program changes are implemented.
CO-PAY PROGRAMS
These programs offer assistance to people with private insurance for the co-payments required to obtain HBV and/or HCV drugs at the pharmacy.
Hepatitis B Virus (HBV)
Bristol-Myers Squibb
Drugs covered: Baraclude
Contact Information: 866-715-9050. Ask the operator to speak to someone about the Baraclude Co-pay Benefits Program and ask for a card to be mailed to you.
Program Details: The co-pay assistance starts after the first $20 of a co-pay has been paid by the consumer. The co-pay assistance then covers up to $100 dollars per prescription per month. Currently the program runs for six months.
Gilead Sciences
Drugs covered: Hepsera, Viread
Contact Information: 888-358-0398
Program Details: The co-pay assistance starts after the first $50 of a co-pay has been paid by the consumer. The co-pay assistance then covers up to $200 dollars per prescription per month. There is also a program for people who pay for their prescription in full that covers the first $200 per month.
Program Details: The co-pay assistance starts at the first dollar paid by the consumer. The co-pay assistance then covers up to $100 dollars per prescription per month and includes non-HBV drugs.
Program Details: People can print out a card at www.victrelis.com, which entitles them to receive up to $200 savings on their copayment for each Victrelis prescription, on up to 12 prescriptions (which would be a full 44 weeks of treatment for those who need it for that duration).
Program Details: Vertex will cover co-pay or co-insurance costs up to 20 percent of the total cost of Incevik for people who have private insurance plans that cover Incevik.
PAP PROGRAMS
These programs offer free HBV and HCV drugs to people with low-incomes who do not qualify for any other insurance or assistance programs, such as Medicaid or Medicare. Different company programs have different eligibility criteria based on the Federal Poverty Level (FPL). The 2010 FPL income for an individual is $10,830 annual income. It is adjusted based on family or household size. 200% FPL is $21,660 annual income for an individual and 300% is $32,490 annual income. A complete table is available at http://aspe.hhs.gov/poverty/10poverty.shtml. Unless otherwise stated, companies ask for verification of income, usually in the form of a federal income tax return. Companies also generally consider household income, meaning that a married couple that files joint taxes would be judged on their combined income. People who file individual income tax returns would only have their individual income considered. Always apply for an exception if told you are not eligible.
Hepatitis B Virus (HBV)
Bristol-Myers Squibb
Drugs covered: Baraclude
Contact Information: 800-736-0003 or visit www.bmspaf.org
Program Details: The PAP is for people who do not qualify for other assistance or health insurance programs and is limited by income. Most programs have limits based on the total household income compared to established FPL percentages. Generally, programs will accept appeals for special circumstances if a person does not initially qualify and is turned down.
Program Details: The PAP is for people who do not qualify for other assistance or health insurance programs and is limited by income. Most programs have limits based on the total household income compared to established FPL percentages. Generally, programs will accept appeals for special circumstances if a person does not initially qualify and is turned down.
Program Details: The PAP is for people who do not qualify for other assistance or health insurance programs and is limited by income. Most programs have limits based on the total household income compared to established FPL percentages. Generally, programs will accept appeals for special circumstances if a person does not initially qualify and is turned down.
Hepatitis C Virus (HCV)
Amgen
Drugs covered: Epogen*
Contact Information: 800-272-9376
Program Details: The PAP is for people who do not qualify for other assistance or health insurance programs and is limited by income. Most programs have limits based on the total household income compared to established federal poverty levels. Generally, programs will accept appeals for special circumstances if a person does not initially qualify and is turned down..
*Epogen is not a treatment for HCV, but it is a treatment for anemia, which is a side effect commonly caused by HCV treatment.
Genentech/Roche
Drugs covered: Pegasys and Copegus
Contact Information: 888-941-3331
Program Details: The PAP is for people who do not qualify for other assistance or health insurance programs and is limited by income. Most programs have limits based on the total household income compared to established federal poverty levels. Generally, programs will accept appeals for special circumstances if a person does not initially qualify and is turned down.
Merck & Co.
Drugs covered: Pegintron, Rebetol and Victrelis
Contact Information: 866-363-6379
Program Details: The PAP is for people who do not qualify for other assistance or health insurance programs and is limited by income. Most programs have limits based on the total household income compared to established federal poverty levels. Generally, programs will accept appeals for special circumstances if a person does not initially qualify and is turned down.
Program Details: The PAP is for people who do not qualify for other assistance or health insurance programs and is limited by income. Most programs have limits based on the total household income compared to established federal poverty levels. The Incivek PAP helps people whose household income is less than $100,000 per year. Generally, programs will accept appeals for special circumstances if a person does not initially qualify and is turned down.
The Fair Pricing Coalition is an ad hoc group of activists who advocate with the pharmaceutical industry regarding the price and patient access to HIV and viral hepatitis drugs. For more information, please visit www.fairpricingcoalition.org.
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