Fpc_papcopay_feb2011_printable

Fair Pricing Coalition
Patient Assistance and Co-Pay Programs for HIV and Viral Hepatitis Drugs
BRISTOL-MYERS SQUIBB (BMS)
Over the past two years, the Fair Pricing Coalition Drugs covered: Atripla, Reyataz, Sustiva, Videx
(FPC) has addressed patient health insurance co- payment (co-pay) programs and patient drug Contact Information: 888-281-8981 for Sustiva
assistance programs (PAPs) for people living with and Reyataz or 866-784-3431 for Atripla or go to
HIV and/or viral hepatitis. The FPC has negotiated the product websites (e.g. www.sustiva.com) co-pay programs with virtually every major HIV Program Details: The program covers the first
drug manufacturer. The FPC is also working on $200 per-month of your co-payment for all BMS expanding PAPs and making it easier for people to HIV products. Currently, a person must reapply for access them, especially for people who have been put on waiting lists for state AIDS Drug Assistance Programs (ADAPs). Following is a list of co-pay and patient assistance programs for HIV and hepatitis B GENENTECH/ROCHE
and C, and contact information for these programs. HIV Drugs covered: None
This is a living document that will be updated as Contact Information: None
Program Details: No program, might cover co-
pays through their patient assistance program.
PROGRAMS FOR HIV
GILEAD SCIENCES
Drugs covered: Atripla, Emtriva, Truvada, Viread
C0-PAY PROGRAMS
Contact Information: 888-358-0398 for
Emtriva, Viread or Truvada or 866-784-3431 for
Atripla or go to product websites
These programs offer assistance to people with private health insurance for the co-payments Program Details: The program covers the first
required to obtain HIV drugs at the pharmacy. $200 per-month of your co-payment for Gilead HIV Some companies offer co-pay assistance for all of products. Currently, a person must reapply for the GLAXOSMITHKLINE See ViiV Healthcare
Drugs covered: Kaletra, Norvir
Contact Information: 800-222-6885, or go to
MERCK & CO
the product websites (e.g. www.kaletra.com) Drugs covered: Isentress
Program Details: The co-pay assistance covers
Contact Information: 866-350-
the first $50 per Kaletra prescription per month, 9232 or www.isentress.com
plus $50 per prescription per month for other drugs Program Details: The program covers the first
in the regimen—up to $100 total for the other $400 per-month of your co-payment for Merck HIV prescriptions. For the Norvir program, Abbott offers products. Currently, a person must reapply for the up to $50 of savings after you pay the first $25 of your co-payment. Abbott will cover the first $50 per Norvir prescription per month beginning February PFIZER See ViiV Healthcare
14, 2011. Currently, a person must reapply for the program each year. TIBOTEC
Drugs covered: Intelence, Prezista
BOEHRINGER INGELHEIM (BI)
Contact Information: 866-961-7169 or go to
Drugs covered: Viramune
product websites (e.g. www.prezista.com) Contact Information: The BI co-pay card is
Program Details: After paying the first $5 of your
distributed by health care and service providers co-payment, you can save up to $100 monthly for up to one year. Currently, you must reapply for the Program Details: The co-pay assistance starts at
the first dollar paid by the consumer. The program covers the first $50 per-month of your Viramune co-payment for all BI HIV products. The program ViiV HEALTHCARE
does not cover Aptivus prescriptions. Currently, a Drugs covered: Combivir, Epivir, Epzicom, Lexiva,
person must reapply for the program each year. Rescriptor, Retrovir, Selzentry, Trizivir, Viracept
and Ziagen.
Contact Information: Call 1-877-844-8872.
Patients can use their current or new card for both Pfizer and GSK drugs, now under one umbrella at ViiV Healthcare. You can get the card from your eligibility, the drug company FPL may also Program Details: The program covers the first
$100 per-month of your co-payment on each ViiV individual company PAP criteria; and
prescription. Currently, you must reapply for the always apply for an exception if you
are told you are not eligible.
Companies participating in the Welvista program are indicated below. PAP AND WELVISTA PROGRAMS
Drugs covered: Kaletra, Norvir
Contact Information: 800-222-6885
Patient Assistance Programs (PAPs) offer free HIV Program Details: The PAP is for people who do
drugs to people with low-incomes who do not not qualify for other assistance or health insurance qualify for any other insurance or assistance programs and is limited by income. Most programs have limits based on the total household income Assistance Programs (ADAPs). Different company compared to established federal poverty levels programs have different eligibility criteria based on (FPL). Abbott’s program covers people with incomes the Federal Poverty Level (FPL) designation. The up to 500 percent of the FPL. Abbott does not 2010 FPL income for one individual is $10,830. It is request income verification and they only consider adjusted based on family or household size. 200% the income of the individual. Generally, programs FPL is $21,660 and 300% $32,490 for individuals. A will accept appeals for special circumstances if a person does not initially qualify and is turned down. http://aspe.hhs.gov/poverty/10poverty.shtml. People initially denied coverage through the PAP Unless otherwise stated, companies ask for should apply a second time and ask for a relevant verification of income, usually in the form of a exception. Abbott currently participates in the federal income tax return. Companies also generally consider household income, meaning that a married couple that files joint taxes would be judged on BOEHRINGER INGELHEIM (BI)
their combined income. People who file individual Drugs covered: Aptivus, Viramune
income tax returns would only have their individual Contact Information: 800-556-
income considered. Always apply for an
8317 or www.rxhope.com or www.pparx.org
exception if told you are not eligible.
Program Details: The PAP is for people who do
A special program which is overseen by the Heinz not qualify for other assistance or health insurance Family Philanthropies, and managed by Welvista, a programs and is limited by income. Most programs non-profit mail-order pharmacy based in South have limits based on the total household income Carolina, has been initiated to make it easier for compared to established federal poverty levels. BI’s people on ADAP waiting lists to access their HIV program covers people with incomes up to 300 medications from one location rather than having to percent of the FPL. Generally, programs will accept access multiple industry PAPs to obtain their appeals for special circumstances if a person does medications for different manufacturers. Thus far, not initially qualify and is turned down. People Welvista is working with six HIV drug companies to initially denied coverage through the PAP should provide HIV drugs for free to individuals on ADAP apply a second time and ask for a relevant exception. BI does not currently participate in the Welvista program. The FPC has listed information on the major HIV drug company PAPs below. Please note: BRISTOL-MYERS SQUIBB (BMS)
Drugs covered: Atripla, Reyataz, Sustiva, Videx
Contact Information: 888-477-
2669 or www.pparx.org or go to product websites
Some companies are covering waiting list (e.g. www.sustiva.com). The Atripla PAP is handled separately at 866-290-4767
Program Details: The PAP is for people who do
not qualify for other assistance or health insurance disenrolled clients through their own PAP programs and is limited by income. Most programs have limits based on the total household income compared to established federal poverty levels. BMS’s program covers people with incomes up to 300 to 500 percent of the FPL, depending on the FPL criteria for each state’s ADAP program. exception. Merck currently participates in the Generally, programs will accept appeals for special circumstances if a person does not initially qualify and is turned down. People initially denied coverage PFIZER See ViiV Healthcare
through the PAP should apply a second time and ask for a relevant exception. BMS currently Drugs covered: Intelence, Prezista
Contact Information: 800-652-6227 or product-
GENENTECH/ROCHE
specific website (e.g. www.prezista.com) Drugs covered: Fuzeon
Program Details: The PAP is for people who do
Contact Information: 877-757-6243
not qualify for other assistance or health insurance Program Details: The PAP is for people who do
programs and is limited by income. Most programs not qualify for other assistance or health insurance have limits based on the total household income programs and is limited by income. Most programs compared to established federal poverty levels have limits based on the total household income (FPL). Tibotec’s program covers people with compared to established federal poverty levels incomes up to 200 percent of the FPL. Generally, (FPL). Genentech’s program covers people with programs will accept appeals for special incomes up to 950 percent of the FPL. Generally, circumstances if a person does not initially qualify programs will accept appeals for special and is turned down. People initially denied coverage circumstances if a person does not initially qualify through the PAP should apply a second time and and is turned down. People initially denied coverage ask for a relevant exception. Tibotec currently through the PAP should apply a second time and ask for a relevant exception. Genentech does not currently participate in the Welvista program. ViiV HEALTHCARE
Drugs covered: Combivir, Epivir, Epzicom, Lexiva,
GILEAD SCIENCES
Retrovir, Selzentry, Trizivir, Viracept and Ziagen. Drugs covered: Atripla, Emtriva, Truvada, Viread
Contact Information: 877-784-
Contact Information: 800-226-2056 or go to
4842 or www.ViiVHealthcareForYou.com
product websites (e.g. www.truvada.com). The Program Details: The PAP is for people who do
Atripla PAP is handled separately at 866-290-
not qualify for other assistance or health insurance programs and is limited by income. Most programs Program Details: The PAP is for people who do
have limits based on the total household income not qualify for other assistance or health insurance compared to established federal poverty levels programs and is limited by income. Most programs (FPL). ViiV’s program covers people with incomes have limits based on the total household income up to 500 percent of the FPL. Generally, programs compared to established federal poverty levels will accept appeals for special circumstances if a (FPL). Gilead’s program covers people with incomes person does not initially qualify and is turned down. up to 500 percent of FPL. Generally, programs will People initially denied coverage through the PAP accept appeals for special circumstances if a person should apply a second time and ask for a relevant does not initially qualify and is turned down. People exception. ViiV currently participates in the Welvista initially denied coverage through the PAP should apply a second time and ask for a relevant exception. Gilead currently participates in the PROGRAMS FOR VIRAL
GLAXOSMITHKLINE See ViiV Healthcare
HEPATITIS
MERCK & CO
Drugs covered: Crixivan, Isentress
CO-PAY PROGRAMS FOR
Contact Information: 800-850-
3430
or www.isentress.com
HEPATITIS B VIRUS (HBV)
Program Details: The PAP is for people who do
not qualify for other assistance or health insurance
These programs offer assistance to people with programs and is limited by income. Most programs private insurance for the co-payments required to have limits based on the total household income compared to established federal poverty levels companies offer co-pay assistance for all of their (FPL). Merck’s program covers people with incomes drugs, including non-HBV drugs. Different company up to 500 percent of the FPL. Generally, programs programs have different eligibility criteria based on will accept appeals for special circumstances if a the Federal Poverty Level (FPL). The 2010 FPL person does not initially qualify and is turned down. income for an individual is $10,830 annual income. People initially denied coverage through the PAP It is adjusted based on family or household. 200% should apply a second time and ask for a relevant FPL is $21,660 annual income for an individual and 300% is $32,490 annual income for an individual. A $21,660 annual income for an individual and 300% is $32,490 annual income. A complete table is http://aspe.hhs.gov/poverty/10poverty.shtml. Always apply for an exception if told you are
http://aspe.hhs.gov/poverty/10poverty.shtml. not eligible.
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 BRISTOL-MYERS SQUIBB
couple that files joint taxes would be judged on Drugs covered: Baraclude
their combined income. People who file individual Contact Information: 866-715-9050. Ask the
income tax returns would only have their individual operator to speak to someone about the Baraclude income considered. Always apply for an
Co-pay Benefits Program and ask for a card to be exception if told you are not eligible.
Program Details: The co-pay assistance starts
after the first $20 of a co-pay has been paid by the
BRISTOL-MYERS SQUIBB
consumer. The co-pay assistance then covers up to Drugs covered: Baraclude
$100 dollars per prescription per month. Currently Contact Information: 800-736-0003 or
visit www.bmspaf.org.
Program Details: The PAP is for people who do
GILEAD SCIENCES
not qualify for other assistance or health insurance Drugs covered: Hepsera, Viread
programs and is limited by income. Most programs Contact Information: 888-358-0398
have limits based on the total household income Program Details: The co-pay assistance starts
compared to established FPL percentages. after the first $50 of a co-pay has been paid by the Generally, programs will accept appeals for special consumer. The co-pay assistance then covers up to circumstances if a person does not initially qualify $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 GILEAD SCIENCES
Drugs covered: Hepsera, Viread
Contact Information: 800-226-2056 or
GLAXOSMITHKLINE
Drugs covered: Epivir
Program Details: The PAP is for people who do
Contact Information: 888-825-
not qualify for other assistance or health insurance 5249 or www.mysupportcard.com
programs and is limited by income. Most programs have limits based on the total household income Program Details: The co-pay assistance starts at
compared to established FPL percentages. the first dollar paid by the consumer. The co-pay Generally, programs will accept appeals for special assistance then covers up to $100 dollars per circumstances if a person does not initially qualify prescription per month and includes non-HBV GlaxoSmithKline
CO-PAY PROGRAMS FOR
Drugs covered: Epivir
Contact Information: 866-475-
HEPATITIS C VIRUS (HCV)
3678 or www.gskforyou.com
Program Details: The PAP is for people who do
There are currently no co-pay assistance programs 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 PAP PROGRAMS FOR HEPATITIS B
circumstances if a person does not initially qualify VIRUS (HBV)
These programs offer free HBV drugs to people with low-incomes who do not qualify for any other PAP PROGRAMS FOR HEPATITIS C
insurance or assistance programs, such as Medicaid or Medicare. Different company programs have VIRUS (HCV)
different eligibility criteria based on the Federal Poverty Level (FPL). The 2010 FPL income for an These programs offer free HCV drugs to low-income individual is $10,830 annual income. It is adjusted people who do not qualify for any other insurance based on family or household size. 200% FPL is or assistance programs, such as Medicaid or Medicare. Different company programs have different eligibility criteria based on the Federal Poverty Level (FPL) designation. The 2010 FPL The  Fair  Pricing  Coalition  is an ad hoc group of
income for one person is $10,830. It is somewhat activists who advocate with the
higher for multi-person households. An eligibility of pharmaceutical industry regarding the price
200% FPL would be twice that ($21,660), 300% and patient access to HIV and viral hepatitis
would be 3-times ($32,490) and so forth. A drugs. For more information, please visit
www.fairpricingcoalition.org.  
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. None of the programs currently
offer assistance with obtaining an HCV viral load
test, however, which is a critical part of HCV
treatment.
Always apply for an exception if told you are
not eligible.

JOHNSON & JOHNSON
Drugs covered: Procrit*
Contact Information: 800-652-6227
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.
*Note: Procrit 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 and Rebetol
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.

February 1, 2011

Source: http://fairpricingcoalition.org/wp-content/uploads/2011/02/FPC_PAPCopay_FEB2011_Printable.pdf

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