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Lesson Help Paying for Meds: Patient Assistance and
Co-Pay Programs for HIV and Viral Hepatitis Drugs
Introduction

Are you uninsured? If you do have health coverage, are your prescription co-pays or other co-insurance costs prohibitively expensive? Or does your health plan come with high medication deductibles that you can't afford? Help may be available from pharmaceutical companies in the form of patient assistance programs (PAPs) and co-pay programs.

In recent 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. Below is a list of co-pay and patient assistance programs for HIV medications as well as meds for hepatitis B and C, including contact information for these programs. This page will be updated as new treatments are released and in the event that these programs evolve over time.

Different pharmaceutical company programs have different eligibility criteria based on the federal poverty level (FPL). The 2013 FPL income for an individual is $11,490. The figure is adjusted based on family or household size. A complete table is available here. 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 will be judged on their combined income. People who file individual income tax returns will only have their individual income considered. If you are told you are ineligible for assistance, this does not mean there is still no chance for you; you can always appeal and hope to have the decision reversed.

PROGRAMS FOR HIV

Co-Pay Programs

These programs offer assistance to people with private health insurance for the co-payments required to obtain HIV drugs at the pharmacy. Some companies offer co-pay assistance for all of their drugs, including non-HIV drugs.

AbbVie (formerly Abbott)
Drugs covered: Kaletra, Norvir
Contact Information: 800-222-6885, or go to the product websites (e.g. www.kaletra.com)
Program Details: The co-pay assistance covers the first $200 per Kaletra prescription per month, and the first $50 per Norvir prescription per month. Currently, a person must reapply for the program each year. The program is accessible online or through healthcare providers.

Bristol-Myers Squibb
Drugs covered: Atripla, Reyataz and Sustiva
Contact Information: 888-281-8981 for Sustiva and Reyataz or 866-784-3431 for Atripla or go to the product websites (e.g. www.sustiva.com)
Program Details: The program covers the first $200 per-month of your co-payment for Reyataz and Sustiva, and the first $400 for Atripla. Currently, a person must reapply for the program each year.  The program is accessible online or through healthcare providers.

Genentech/Roche
HIV Drugs covered: Fuzeon
Contact Information: 866-422-2377, or go to www.genentech-access.com
Program Details: Makes contributions to non-profit programs that will cover co-pays for both private insurance patients and Medicare Part D patients.

Gilead Sciences
Drugs covered: Atripla, CompleraEmtriva, Stribild, Truvada, Viread
Contact Information: 877-505-6986, or go to product websites (e.g. www.truvada.com)
Program Details: The program covers the first $400 per-month of your co-payment for Atripla, Complera, and Stribild; and the first $200 per month of your co-payment for Emtriva, Truvada and Viread. The program automatically renews annually for enrolled patients. The program is accessible through healthcare providers, community based organizations and pharmacies.

Janssen Therapeutics
Drugs covered: EdurantIntelence, Prezista
Contact Information: 866-961-7169 for Edurant, Intelence or Prezista, or go to product websites (e.g. www.prezista.com). You can also get all of the relevant information or forms including an instant savings card at www.janssentherapeutics.com.
Program Details: After paying the first $5 of your co-payment, there is no limit on the amount of the remaining co-pay Janssen will cover. Currently, you must reapply for the program each year.  The program is accessible online or through healthcare providers.

Merck & Co.
Drugs covered: Isentress
Contact Information: 855-834-3467 or www.isentress.com
Program Details: The program covers the first $400 per-month of your co-payment for Merck HIV products. Currently, a person must reapply for the program each year. The program is accessible online or through healthcare providers.

ViiV Healthcare
Drugs covered: Combivir, Epivir, Epzicom, Lexiva, Rescriptor, Retrovir, Selzentry, Tivicay, Trizivir, Viracept and Ziagen
Contact Information: 877-844-8872. Effective February 1, 2013, patients must get a new card and re-enroll for 2013. You can get the card from your provider or print out the card online at www.mysupportcard.com, or call the number above. To activate the new card, call 855-208-3317 or go to www.activatethecard.com/gsk.
Program Details: The program covers the first $200 per-month of your co-payment on each ViiV prescription. Because of a one time change in the program, all patients must reapply in 2013.

Patient Assistance Programs (PAP’s), CPAPA and HarborPath for HIV

Patient Assistance Programs (PAPs) offer free HIV drugs to people who do not qualify for assistance programs such as Medicaid, Medicare, or AIDS Drug Assistance Programs (ADAPs). Different company programs have different eligibility criteria based on the Federal Poverty Level (FPL) designation. The 2013 FPL income for one individual is $11,490.  It is adjusted based on family or household size. 200% FPL is $22,980 and 300% is $34,470 for individuals. All levels are somewhat higher in Alaska and Hawaii. A complete table is available here.

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.

Two other recent developments that will potentially ease access to PAPs are the Common PAP Application (CPAPA) and HarborPath. The Department of Health and Human Services (DHHS), along with seven pharmaceutical companies, the National Alliance of State and Territorial AIDS Directors (NASTAD), and community stakeholders developed a common patient assistance program application that can be used by both providers and patients. Before, patients and advocates had to fill out different sets of paperwork for each company; the new application should help simplify this process, however the form still has to be sent to each company program you are applying to for assistance. Click here for the form.

HarborPath is a non-profit organization that helps uninsured individuals living with HIV/AIDS gain access to brand-name prescription medicines at no cost, by providing case managers with a single “one-stop shopping” online portal for PAP applications and medication fulfillment through a mail-order pharmacy. Currently in its pilot phase in six states with most HIV pharmaceutical companies on board for ADAP waiting list clients, there are plans for expansion in 2013, including adding medicines for hepatitis C. (Merck participates with its HCV drug Victrelis.) Go to harborpath.org for more information.

Please note:

Most companies are using HarborPath for ADAP waiting list patients.
 
Boehringer Ingelheim and Genentech are covering ADAP waiting list patients only through their own PAPs.
 
Other companies are covering ADAP waiting list patients through both HarborPath and their own PAPs.
 
Some companies are also covering ADAP disenrolled clients through their own PAP programs and some are not.
 
If an ADAP patient has been disenrolled because the state has lowered FPL eligibility, the drug company FPL may also be too low to cover them. Check the individual company PAP criteria; and always apply for an exception if you are told you are not eligible.

In some instances, Medicare Part D clients, as well as the underinsured who have co-insurance, deductibles, caps or co-pays they cannot afford, are covered 100% by the PAP; eligibility is based on both projected out of pocket drug/medical expenses and income. Both underinsured and people with no insurance who are initially denied coverage through the PAP should always ask for an exception or an appeal.

AbbVie (formerly Abbott)
Drugs covered: Kaletra, Norvir
Contact Information: 800-222-6885 or www.abbottpatientassistancefoundation.org.
Program Details: The PAP is for people who do not qualify for other assistance. AbbVie’s program covers people with incomes up to 500 percent of the FPL. AbbVie does not request income verification and they only consider the income of the individual. In some instances, Medicare Part D clients, as well as the underinsured who have co-insurance, deductibles, caps or co-pays they cannot afford, are covered 100% by the PAP; eligibility is based on both projected out of pocket drug/medical expenses and income. Both the underinsured and people with no insurance who are initially denied coverage through the PAP should always ask for an exception or an appeal. AbbVie currently participates in the HarborPath ADAP waiting list program.

Boehringer Ingelheim
Drugs covered: Aptivus, Viramune
Contact Information: 800-556-8317 or www.rxhope.com or www.pparx.org.
Program Details: The PAP is for people who do not qualify for other assistance. BI’s program covers people with incomes up to 500 percent of the FPL. In some instances, Medicare Part D clients, as well as the underinsured who have co-insurance, deductibles, caps or co-pays they cannot afford, are covered 100% by the PAP; eligibility is based on both projected out of pocket drug/medical expenses and income. Both underinsured and people with no insurance who are initially denied coverage through the PAP should always ask for an exception or an appeal. BI currently does not participate in the HarborPath ADAP waiting list program.

Bristol-Myers Squibb
Drugs covered: Atripla, Reyataz and Sustiva
Contact Information: 888-281-8981 or www.bms.com or go to product websites (e.g. www.sustiva.com). The Atripla PAP is handled separately at 866-290-4767 or go to www.atripla.com.
Program Details: The PAP is for people who do not qualify for other assistance. The BMS program covers people with incomes up to 500 percent of the FPL. In some instances, Medicare Part D clients, as well as the underinsured who have co-insurance, deductibles, caps or co-pays they cannot afford, are covered 100% by the PAP; eligibility is based on both projected out of pocket drug/medical expenses and income. Both underinsured and people with no insurance who are initially denied coverage through the PAP should always ask for an exception or an appeal. BMS currently participates in the HarborPath ADAP waiting list program.

Genentech/Roche
HIV Drugs covered: Fuzeon
Contact Information: 877-757-6243
Program Details: The PAP is for people who do not qualify for other assistance .Genentech’s program covers people with incomes up to 950 percent of the FPL. Genentech does not currently participate in the HarborPath ADAP waiting list program. Genentech will also assist Medicare Part D clients, as well as the underinsured who have co-insurance, deductibles, caps or co-pays they cannot afford, by referring them to non-profit foundations that may be able to assist them; eligibility is based on both projected out of pocket drug/medical expenses and income.

Gilead Sciences
Drugs covered: Atripla, CompleraEmtriva, Stribild, Truvada, Viread
Contact Information: 800-226-2056 or go to www.gilead.com/us_advancing_access. The Atripla PAP is handled separately at 866-290-4767 or go to www.atripla.com.
Program Details: The PAP is for people who do not qualify for other assistance. Gilead’s program covers people with incomes up to 500 percent of FPL. In some instances, Medicare Part D clients, as well as the underinsured who have co-insurance, deductibles, caps or co-pays they cannot afford, are covered 100% by the PAP; eligibility is based on both projected out of pocket drug/medical expenses and income. Both underinsured and people with no insurance who are initially denied coverage through the PAP should always ask for an exception or an appeal. Gilead currently participates in the HarborPath ADAP waiting list program.

Janssen Therapeutics
Drugs covered: Edurant, Intelence, Prezista
Contact Information: 800-652-6227 or Johnson & Johnson's Patient Assistance Foundation (www.jjpaf.org) or product-specific website (e.g. www.prezista.com).
Program Details: The PAP is for people who do not qualify for other assistance. Janssen’s program covers people with incomes up to 200 percent of FPL, but makes exceptions to their FPL eligibility criteria. In some instances, Medicare Part D clients, as well as the underinsured who have co-insurance, deductibles, caps or co-pays they cannot afford, are covered 100% by the PAP; eligibility is based on both projected out of pocket drug/medical expenses and income. Both underinsured and people with no insurance who are initially denied coverage through the PAP should always ask for an exception or an appeal. Janssen currently participates in the HarborPath ADAP waiting list program.

Merck & Co.
Drugs covered: Crixivan, Isentress
Contact Information: 800-850-3430 or www.isentress.com
Program Details: The PAP is for people who do not qualify for other assistance. Merck’s program covers people with incomes up to 500 percent of the FPL. In some instances, Medicare Part D clients, as well as the underinsured who have co-insurance, deductibles, caps or co-pays they cannot afford, are covered 100% by the PAP; eligibility is based on both projected out of pocket drug/medical expenses and income. Both underinsured and people with no insurance who are initially denied coverage through the PAP should always ask for an exception or an appeal. Merck currently participates in the HarborPath ADAP waiting list program.

ViiV Healthcare
Drugs covered: Combivir, Epivir, Epzicom, Lexiva, Rescriptor, Retrovir, Selzentry, Tivicay, Trizivir, Viracept and Ziagen
Contact Information: 877-784-4842 or www.viivhealthcareforyou.com.
Program Details: The PAP is for people who do not qualify for other ViiV’s program covers people with incomes up to 500 percent of the FPL. In some instances, Medicare Part D clients are covered 100% by the PAP after $600 out of pocket patient expenses. People initially denied coverage through the PAP should always ask for an exception or an appeal. ViiV currently participates in the HarborPath ADAP waiting list program.

PROGRAMS FOR VIRAL HEPATITIS

Co-Pay Programs

These programs offer assistance to people with private insurance for the co-payments required to obtain hepatitis B and/or hepatitis C drugs at the pharmacy.

Hepatitis B Virus (HBV)

Bristol-Myers Squibb
Drugs covered: Baraclude
Contact Information: 855-898-0267. 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 program covers the first $200 per month of co-pays.  For people who pay for their prescriptions in full, the program will also cover the first $200 per month.  Currently the program runs through December 31, 2014.

Gilead Sciences
Drugs covered: Viread
Contact Information: 877-627-0415
Program Details: The program starts after the first $50 and covers up to $200 per month co-payment for Viread for HBV treatment for patients who are uninsured or pay their prescription costs in full.  The program renews automatically for enrolled patients.

ViiV Healthcare
Drugs covered: Epivir
Contact Information: 877-844-8872 or www.mysupportcard.com
Program Details: The program covers up to $200 dollars per prescription per month and includes non-HBV drugs.

Hepatitis C Virus (HCV)

Gilead Sciences
Drugs covered: Sovaldi (sofosbuvir)
Contact Information: 855-769-7284 or www.MySupportPath.com
Program Details:Support The Sovaldi Copay Coupon Program can bring copays down to $5 in most cases for those who qualify. Financial aid for as much as $16,000 is also available to go toward prescription deductibles and coinsurance obligations.  The program is open to those with a maximum household income of $100,000 for up to a family of three, and 500 percent of federal poverty level for families with four or more members.

Johnson & Johnson/Janssen
Drugs covered: Olysio (simeprevir)
Contact Information: 855-5-OLYSIO or www.olysio.com
Program Details:The Janssen Therapeutics Patient Savings program assists those who qualify by reducing their copays or coinsurance for Olysio to no more than $25 a month. This translates to a total of $75 for the three-month regimen of the drug in most cases. The maximum financial assistance is $25,000 for the 12-month period after you qualify, or until you've filled three bottles of Olysio, whichever comes first. To qualify, your household income must be under 500 percent of the federal poverty level, although you can appeal for total coverage if your income is higher. This offer is not available for those enrolled in Medicare or Medicaid.

 
Merck & Co.
Drugs covered: PegIntron and Victrelis
Contact Information: 866-939-4372 or www.victrelis.com and www.pegintron.com
Program Details: Victrelis: People can print out a card at www.victrelis.com and at merck-cares.com which offers eligible patients savings of up to 20 percent of the total cost of 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). PegIntron: People can print out a card at www.pegintron.com and at merck-cares.com, which offers eligible patients up to $200 savings on their copayment for each Pegintron prescription, on up to 12 prescriptions.

Vertex Pharmaceuticals
Drugs covered: Incivek
Contact Information: 855-837-8394 or www.incivek.com
Program Details: Vertex will cover co-pay costs up to $10,000 for people who have private insurance plans that cover Incivek, regardless of their household income.

PAP Programs

These programs offer assistance to people with private insurance for the co-payments or coinsurance costs required to obtain hepatitis B or hepatitis C drugs at the pharmacy.

Hepatitis B Virus (HBV)

Bristol-Myers Squibb
Drugs covered: Baraclude
Contact Information: 855-898-0267 or visit www.bmspaf.org
Program Details: The PAP is for people who do not qualify for other assistance or health insurance programs and covers people with Incomes up to 300 percent of the FPL. 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.

Gilead Sciences
Drugs covered: Hepsera, Viread
Contact Information: 800-226-2056 or visit www.gilead.com/us_advancing_access
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.

ViiV Healthcare
Drugs covered: Epivir
Contact Information: 877-784-4842 or www.viivhealthcareforyou.com
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)

Genentech/Roche
Drugs covered: Pegasys and Copegus
Contact Information: 888-941-3331 or www.pegasysaccesssolutions.com.
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.

Gilead Sciences
Drugs covered: Sovaldi (sofosbuvir)
Contact Information: 855-769-7284 or www.MySupportPath.com.
Program Details: Called Support Path, Gilead's program may provide Sovaldi coverage for free to those with a maximum household income of $100,000 for up to a family of three, and 500 percent of federal poverty level for families with four or more members. You can also contact Support Path for assistance finding other sources of health coverage, such as through Medicaid, Medicare or the new health exchanges available through Obamacare.

Johnson & Johnson
Drugs covered: Procrit*, Olysio (simeprevir)
Contact Information: 800-652-6227 or www.jjpaf.org.
Program Details:The Johnson & Johnson Patient Assistance Foundation will provide free coverage of Olysio to those who qualify. The income limit is 500 percent of the federal poverty level, although you can appeal if your income is higher than that. For Procrit, the income cap is 400 percent FPL.
*Procrit is a treatment for anemia—a side effect commonly caused by the drug ribavirin, which is a component of many hepatitis C regimens.

Merck & Co.
Drugs covered: Pegintron and Victrelis
Contact Information: 866-363-6379 or www.merckhelps.com.
Program Details: The ACT Program can help you answer questions related to insurance coverage and reimbursement. Program Specialists can also help you apply for the PAP. 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 the program will accept appeals for special circumstances if a person does not initially qualify and is turned down, provided they fall within the 500% FPL income eligibility requirement.

Vertex Pharmaceuticals
Drugs covered: Incivek
Contact Information: 855-837-8394 or www.incivek.com
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 above is based on a document originally produced by the Fair Pricing Coalition, 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.

Last Revised: 7/10/14
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