Wednesday, July 13, 2016

HIV Drug Assistance Programs


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 the following:

Co-Pay Programs
Patient Assistance Programs (PAPs)
AIDS Drug Assistance Program (ADAP)
Medicaid

Different assistance programs have different eligibility criteria based on the federal poverty level (FPL). Eligibility for this year is based on last year's income. 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. In many cases, if you are told you are ineligible for assistance, you can appeal to have the decision reversed.

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 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, Complera, Descovy, Emtriva, Genvoya, Stribild, Truvada, Tybost, Viread
Contact Information: 877-505-6986, or go to product websites (e.g. www.truvada.com)
Program Details: The program covers the first $6,000 per year of your co-payment for Atripla, Complera, and Stribild; the first $300 per month/$3,600 per year of your co-payment for Emtriva, Truvada and Viread; and the first $50 per month/$600 per year of your co-payment for Tybost. The program automatically renews annually for enrolled patients. The program is accessible through healthcare providers, community based organizations and pharmacies.
 
Janssen Therapeutics (formerly Tibotec Therapeutics)
Drugs covered: Edurant, Intelence, 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 or www.activatethecard.com/6919/
Program Details: The program covers the first $400 of your co-payment for Isentress for each of 12 eligible prescriptions. Currently, a person must reapply for the program after 12 prescriptions have been filled. The program is accessible online.
 
ViiV Healthcare
Drugs covered: Combivir, Epivir, Epzicom, Lexiva, Rescriptor, Retrovir, Selzentry, Tivicay, Triumeq, Trizivir, Viracept and Ziagen
Contact Information: 866-747-1170 or visit www.mysupportcard.com.
Program Details: The program provides savings up to $6,000 per year for medications including Tivicay and Triumeq. Savings up to $2,400 per year for each of the other eligible ViiV Healthcare products. Total savings not to exceed $6,000 per year.


PATIENT ASSISTANT PROGRAMS (PAPs)

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).
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, including adding medicines for hepatitis C. 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 go to product specific websites (e.g. www.kaletra.com).
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 XR
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 makes exceptions to their income eligibility criteria.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, Complera, Descovy, Emtriva, Genvoya, Stribild, Truvada, Tybost, Viread
Contact Information: 800-226-2056 or go to www.gilead.com/responsibility/us-patient-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 (formerly Tibotec Therapeutics)
Drugs covered: Edurant, Intelence, Prezista
Contact Information: 800-652-6227 or 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, Triumeq, 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.

AIDS DRUG ASSISTANCE PROGRAMS (ADAP)

The Ryan White CARE Act is the largest federally funded program for people with HIV. It provides care and support services to people who don’t have insurance or don’t have enough coverage through their other plans. Ryan White also provides funding for ADAP. Here's info on how to find out more about ADAP in your state:




MEDICAID

A little over half of all Americans with HIV get their meds and health care through these federal programs. Currently you can qualify for Medicaid if you have a low income and are part of a “categorically eligible” group (children, parents with dependent children, pregnant women, and people with disabilities). In 2014, states have the option of allowing you to be eligible for Medicaid without being disabled (or part of any other eligible group) if your income is 133 percent below the federal poverty level. Here's info on how to find out more about Medicaid options in your state:


Looking for drug assistance programs for viral hepatitis? Please visit hepmag.com.

The PAP and co-pay program information on this page 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: January 13, 2016

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