As JM families, we understand how daunting a task navigating treatments can be, from dealing with insurance roadblocks to navigating the healthcare system and everything in between.
We are excited to share some pro tips that we became aware of from a September presentation to Cure JM grandparents from a couple of Pharmaceutical Industry experts.
No matter where you are in your family’s JM journey or what your individual situation may be, we hope you find these tips and assistance programs helpful in navigating your treatment options.
The experts Laurel Cherwin, BSN, RN, IgCN, and Senior Clinical Nurse Educator at Octapharma and Michelle Vogel, Vice President of Patient Advocacy at IV Solutions RX, MPA had some great tips for our Cure JM Families.
Laurel Cherwin recommended families should:
- Request a case manager from the insurance company to streamline the care process and address access issues.
- Collaborate closely with the patient’s doctor when navigating the insurance approval and appeal process to find the best course of action.
- Maintain patience and persistence when dealing with insurance companies due to the complexities of authorization for coverage, and keep a detailed journal of interactions while requesting a call ID number for future reference.
Michelle Vogel suggests families should:
- Explore copay assistance programs, pharmaceutical assistance programs, and patient assistance foundations to help manage the financial burden of expensive medications.
- Look into medical assistance programs at infusion centers and physician offices, even if they are not widely advertised.
- Consider seeking funding assistance through third parties and government sources to make therapies more affordable.
IVIG Copay Assistance Programs
- Bivigam up to $6,000 www.asceniv.com/ADvantageIg-Patient-Support-Program.pdf
- Gammaplex up to $2,500 https://gammaplex.medmonk.com
- Octapharma has assistance program for brands Octagam – $2,500, Panzyga – $12,500 and Cutaquig $12,500 https://igcares.com/home/copay-support.html
- Pfizer has assistance program for Octagam and Panzyga up to $12,500 https://panzyga.pfizerpro.com/support/co-payprogram-for-patients
Other Drug Copay Assistance Programs
- Actor Gel up to $15,000- www.acthar.com/financial-assistance
- Avsola (infliximab-axxq) $0 out of pocket- www.amgensupportplus.com
- baricitinib (Olumiant) please visit the Olumiant Together Patient Assistance Program: This program from Eli Lilly, the manufacturer of Olumiant, can help eligible commercially insured patients with their co-pays. You can check eligibility and enroll online or by calling 1-844-OLUMIANT (1-844-658-6426). Savings & Support | HCP | Olumiant® (baricitinib) (lilly.com). Also visit the Lilly Cares Foundation: This non-profit organization provides free medications to eligible patients who meet certain income requirements. You can learn more and see if you qualify on their website.
- CellCept (mycophenolate mofetil)- will say up to $330 per prescription/refill after patient has paid the first $20- www.cellcept.com/copaycard
- Deucravacitinib Bristol Myers Squibb Patient Assistance Foundation (BMSPAF): This program from Bristol Myers Squibb, the manufacturer of Sotyktu®, can help eligible patients with their co-pays. You can check eligibility and enroll online or by calling 1-800-736-0003. Sotyktu Patient Support Program: This program offers co-pay assistance and other resources to eligible patients. More information is expected to be available soon on the official Sotyktu® website: https://www.sotyktu.com/.
- Enbrel (etanercept) $0 out-of-pocket for first 6 months; $10 or less each month after 6 months- www.Enbrel.com/support/financial-assistance/
- Entyvio (vedolizumab) pay as little as $5 per does up to $20,000 per year- www.Entyvio.com/copay-support
- Humira pay as little as $5 copay- www.humira.com/global/starting-humira
- Inflectra (infliximab-dyyb) up to $20,000- www.pfizerencompass.com/pt/inflectra/rigtpatientsupport
- Orencia (abatacept) $5 per month up to $10,000 per year- www.Orencia.bmscustomerconnec.com/Orencia-on-call-patient-support#financial-support
- Otrexup (methotrexate) $0 copay- www.otrexup.com/co-pay-card
- Plaquenil (hydroxychloroquine) $0 copay- http://rxoutreach.org//wp-content/uploads/current/Plaquenil-application.pdf
- Prograf (tacrolimus) $0 copay up to $3,000- www.program.com/savings-information
- Rasuvo (methotrexate) $125 in copay assistance- https://rasuvo.pbmplus.com/
- RAYOS (prednisone) $0 copay- www.rayosrx.com/save-on-rayos
- Remicade (infliximab) $5 per infusion- https://remicade.janssencarepathsavings.com/#/app/home
- Reflexes (infliximad-abda) $5 copay- www.merckaccessprogram-renflexis.com/hcc/infusion-copay-cost-assistance/
- Rituxan (rituximab) $5 copay up to $25,000 per year (FDA-approved indications only) www.Rituxan.com./cll/financial-support/assistance-options.html/
- Xeljanz (tofacitinib citrate) up to $8,000 per year- https://www.xeljanz.com/savings-and-support/
Pharmaceutical Assistance
- AbbVie – Patient Assistance Foundation www.abbviepaf.org
- Amgen – Amgen Assist www.amgenassist.com/index.jsp
- AstraZeneca – AZ&Me www.astrazeneca-us.com/medicines/help-affording-your-medicines/azandme-prescription-savings-programs
- Bristol-Meyers Squibb – BMS Access Support www.bmsaccessupport.bmscustomerconnect.com/find-financial-support-info
- Eli Lilly – Lilly TruAssist www.lillytruassist.com/
- Genentech – Genentech Rheumatology Access Solutions www.genetech-access.com/
- GlaxoSmithKline – GSK for you www.gskforyou.com/index.html
- Horizon Pharma – Patient Assistance Program www.RxHope.com/Horizon
- Johnson & Johnson – Johnson and Johnson Patient Assistance Foundation www.jjpaf.org
- Mallinckrodt Pharmaceuticals – Patient Assistance Program http://www2.Mallinckrodt.com/Brands/Patient_Assistance_Brands/
- Novartis – Patient Assistance Now – www.patientassistancenow.com/index.jsp
- Pfizer – Pfizer RxPathways – http://pfizerrxpathways.com
- The Safety Net Foundation – provides Enbrel for free funded through Amgen – www.safetynetfoundation.com/index.html
- Sanofi – Sanofi Patient Access Connection – www.sanofipatientconnection.com/
The Assistance Funds
Eligibility Criteria: U.S. citizen or permanent resident, Prescribed an FDA-approved treatment, Meet Financial eligibility criteria based, and upon household income and size https://enroll.tafcares.org
Covered Drugs: A-Hydrocort, A-Methapred, Acthar, Beta 1 Kit, Bethamethasone Acetate Pow, Bethamethasone Sodium Phosphate, Cortef, Cortisone Acetate, Depo-Medrol, Dexamethasone, Dexpak, Hydrocortisone, Kenalog-40, Medrol, Methylprednisolone, Millipede, Octagam, Prednisone, Pro-C Dure, Purified Cortrophin Gel, Rayos, Solu-Cortef, and Solu-Medrol.
Myositis Support
- Must be a U.S. resident diagnosed with a type of inflammatory myopathy or be going through a diagnostic process in which doctors strongly suspect and are testing the patient for one of the forms of myositis through muscle or skin biopsy, EMG, and/or blood work.
- Requests for assistance are evaluated on a case-by-case basis and are subject to funding availability as well as eligibility and financial need.
- Patients may be eligible to receive up to a maximum of $2,000 once per rolling 24 months from MSU
- Program covers medical bills, emergency household expenses and mobility devices
- For more information, www.understandingmyositis.org/programs/financial-assistance-program/
Other Resources
- Contact your hospital social work department
- Patient Assistance Programs: Several independent organizations offer assistance to patients with high medication costs. These programs vary in eligibility requirements and benefits. You can search for programs in your area using resources like:
- NeedyMeds: URL
- Patient Advocate Foundation: URL
- RxHope: URL
- Copay Cards: Pharmaceutical companies often offer copay cards that can help reduce the cost of their medications. You can find a list of current copay cards on the website of the Partnership for Prescription Assistance: URL
- State and Local Assistance Programs: Some states and local governments offer programs to help residents with the cost of medications. You can find more information about these programs by contacting your state or local health department.
