Prescription Assistance Programs This material has been created or - PowerPoint PPT Presentation

Prescription Assistance Programs This material has been created or produced by CLAIM with financial assistance, in whole or part, through a grant from the Administration for Community Living. Funding is administered through the Missouri Department of Commerce and Insurance and service is provided by Primaris Foundation, a non-profit organization. THE LINK BETWEEN YOU AND MEDICARE

Learning Objectives Be familiar with the resources available to find assistance programs Review common Prescription Assistance Programs (PAPs) and their recent changes Be able to use fundfinder to find assistance from Foundation Assistance Programs Review other techniques to minimize drug costs Understand the potential financial benefit of using assistance programs

Prescription Assistance Programs “Finding non -governmental assistance programs for a Medicare beneficiary’s higher cost drugs can result in MEGA SAVINGS for the beneficiary, which may be much more beneficial than finding the lowest cost Medicare drug plan.” Anonymous

First Step Always screen the beneficiary for Extra Help or Low Income Subsidy (LIS) with SSA Benefits are lower premiums, deductibles and copays Beneficiaries eligible for Extra Help may not be eligible for other assistance programs

Benefits of Extra Help (LIS)

Types of Assistance Programs Patient (Manufacturer) Assistance Programs (PAPs) Foundation (Charity) Assistance Programs

Recommended Tools CLAIM website List of PAP programs for common drugs, eligibility requirements and contact information Included in volunteer resources under tip sheets Needymeds.org Rxassist.org Fundfinder.panfoundation.org

Patient Assistance Programs (PAPs) Many higher cost brand name drugs have PAPs from the manufacturer If eligible, medications are normally provided at no cost Some PAPs exclude Medicare beneficiaries Some PAPs consider Medicare beneficiaries on a case by case basis

Eligibility Requirements for PAPs Income limits – 200%-600% of FPL 200% single $2127/mo couple $2873/mo 600% single $6380/mo couple $8620/mo No asset/resource limit For some PAPs, beneficiary can’t be eligible for LIS For some PAPs, CY OOP costs on meds have to exceed 2%-4% of annual household income For some PAPs, CY OOP costs on meds must exceed a fixed dollar amount

Program Lists on CLAIM Website Insulin and diabetes medications Inhalers Other common medications

Insulin/Diabetes Assistance

Inhaler Assistance

Other Rx Assistance

Case Study Drug : Imbruvica Disease: Chronic lymphocytic leukemia Full price of drug: $12K-$13K per MONTH Extra Help: Not eligible Planfinder pdp costs Initial month $2500 (thru coverage gap) Catastrophic coverage $600-$700 per month

Case Study Manufacturer assistance program Johnson & Johnson Eligibility: Income less than 600% of FPL Single $6380/mo, Couple $8620/mo Result: MEGA SAVINGS

Types of Assistance Programs Patient (Manufacturer) Assistance Programs (PAPs) Foundation (Charity) Assistance Programs

Foundation Assistance Programs Individual funds for specific diseases Dependent on funding Each fund may close, reopen or limit it to renewals at any time Most income limits are 400%-500% of FPL 400% single $4253/mo couple $5747/mo 500% single $5316/mo couple $7184/mo

Foundation Assistance Programs No asset/resource limits Most operate with fixed amount of a grant that pays copays of a Medicare plan Some funds also give assistance for premiums or medical costs

Common Foundation Programs Patient Assistance Network (panfoundation.org) Healthwell (healthwellfoundation.org) My Good Days (mygooddays.org) The Assistance Fund (tafcares.org) Leukemia & Lymphoma Society (lls.org) Cancer Cares (cancercare.org) Patient Advocate (copays.org) Patient Services Inc (patientservicesinc.org)

Fundfinder One website to find or follow disease funds Includes nine foundation assistance programs Includes over 200 diseases/conditions Identifies open and closed disease funds with links to foundations Will send an email when a closed fund opens again Fundfinder.panfoundation.org (Bookmark it!)

Other Counseling Tips for Rx Costs Generics/Samples/Alternative Rx Formulary and tier exceptions Preferred network pharmacies 90 day supply/mail order Good Rx/Singlecare Other discount programs Missouri Rx

STARS Entry

Prescription Assistance Programs Share Your Experiences!! dthran@missouriclaim.org 417-812-6021

Thank You! Questions?