Prescription Assistance Programs

Prescription Assistance Programs for MS Disease-Modifying Therapies

Aubagio

Program name: MS One 2 One
Phone: (855) 676-6326
Website: www.aubagio.com

MS One 2 One will assist patients in the following ways:

1. Individuals with no insurance, or with only Medicare part A and B (but not D), may register for the Patient Assistance Program (PAP). Eligible individuals must be a United States resident with a Social Security number. The household income must also be less than or equal to $100,000. If qualified, the eligible individual will have no out of pocket expense. Program participants must reapply each year. As noted earlier, individuals with Medicare part A and B may apply for assistance; individuals with part D are not eligible.
   
   
2. For individuals with private insurance, co-pay assistance is available. If eligible, the applicant will receive the first three months at no cost. For every month thereafter until 12 months, the co-pay is $35. Program participants must reapply each year. Although there is no financial limit for income, only individuals with private insurance may apply.

*Patients covered by federal and state healthcare programs are not eligible for assistance (excluding individuals on Medicare without part D who are otherwise eligible under the PAP program).

Avonex

Program name: MS ActiveSource
Phone: (800) 456-2255
Website: www.avonex.com

MS ActiveSource will assist patients in the following ways:

1. If the person has insurance (including Medicare), they will give co-pay assistance. The patient's co-pay will be $10 monthly, and this program is ongoing and will not end.
   
   
2. If the person has no insurance, they will help through the Access Program. The drug will be free for two years. There is an undisclosed financial eligibility criterion. After a year and a half, the person will need to reapply. If he or she is not eligible at this time, then the individual will be referred to the National MS Society.

*Federal and State laws may prevent eligibility. People covered by Medicare, Medicaid, the VA/DoD, or some other federal plans may not be eligible. Residents of Massachusetts are not eligible.

Betaseron

Program name: BetaPlus
Phone: (800) 788-1467
Website: www.betaseron.com

BetaPlus will assist patients in the following ways:

1. For people with no insurance, or if they have Medicare, they can apply for the Patient Assistance Program. If they are approved, they can receive a three-month supply for a participation fee ranging from $30 to $150. There is an undisclosed financial eligibility criterion. This will continue for one year, at which time they can reapply. If they are not eligible at this time, they will be referred to a list of agencies for assistance.
   
   
2. If they have insurance, they can receive co-pay assistance up to $9,500 yearly. Patients will have no co-pay expense until they reach the maximum assistance limit of $9,500 yearly.

*Patients who are enrolled in any type of government insurance or reimbursement programs are not eligible.

Copaxone

Program name: Shared Solutions
Phone: (800) 887-8100
Website: www.copaxone.com

Shared Solutions will assist patients in the following ways:

1. Individuals with no insurance are referred to Assist RX. The Shared Solutions case manager will conference-call with the patient and the Assist RX organization. The information about eligibility is not public. An individual's cost would be zero for one year. He or she will then need to reapply. If not eligible at this time, there is no further assistance.
   
   
2. If a person is on Medicare, the Medicare Team, working with a specialty pharmacy (ACS) will pay through the coverage gap. This program is ongoing.
   
   
3. For people with private insurance, the Co-Pay Solutions program will assist. Individuals pay $35 monthly. This program is ongoing.

*The offer is not valid for patients covered in whole or in part by Medicaid, Medicare, TRICARE, or any other federal or state government pharmaceutical assistance plan or program (regardless of whether a specific prescription is covered), or by private health benefit programs that reimburse for the entire cost of prescription drugs.

Extavia

Patient Services Program
Phone: (866) 925-2333
Website: www.extavia.com

Extavia's Patient Services Program will assist patients in the following ways:

1. For individuals with no insurance and who meet the financial criteria, they can receive free medication up to one year, at which time they may reapply. The financial criteria are not public.
   
   
2. For individuals who have insurance with a high co-pay, they can receive assistance if they are financially eligible. This is also true if they have Medicare and need help with the coverage gap.

Both of these programs require that the patient reapply after one year. If the patient is no longer eligible at this time, referrals are made to other agencies.

*The EXTAVIA Co-Pay Program offer is not valid for prescriptions for which payment may be made in whole or in part under federal or state health programs, including but not limited to Medicare or Medicaid, or for residents of Massachusetts.

Gilenya

Patient Services Program
Phone: (877) 408-4974
Website: www.gilenya.com

Gilenya's Patient Services Program will conduct a benefits investigation and determine on an individual basis what assistance a person may be eligible to receive. They can provide a free starter packet while this is proceeding. The program will assist patients in the following ways:

1. For individuals with no insurance, they can receive free medication if their income is less than five times the Federal Poverty Level, under the Patient Assistance Foundation. People with Medicare can also receive assistance in this program. The benefit continues for one year, at which time the patient may reapply. If there is an alternative program, the patient will be referred.
   
   
2. For individuals with commercial insurance, they can receive help up to $800 monthly under the Medical Co-Pay Support Program. This program is based on the present calendar year. There is currently no information available on this program beyond December 31, 2011.

Please note that certain states are not covered under these programs. Individuals living in those states need to ask the Patient Services representative about other assistance.

Rebif

Program name: MS Lifelines
Phone: (887) 447-3243
Website: www.mslifelines.com

MS Lifelines will assist patients in the following ways:

1. If a person has no insurance, he or she will be provided with free medication for up to one year, under the Access Made Simple program. At that time, the patient may reapply and is often still eligible.
   
   
2. If a person has Medicare, he or she may apply for assistance once reaching the coverage gap. This assistance is also available for one year, and a person may reapply after that time.
   Both 1 and 2 require financial eligibility, the terms of which are not disclosed. If the person is not eligible when reapplying, there is no further assistance available.
   
   
3. If a person is insured but has a high co-pay, there is a program to assist. For the first three months, there will be no cost, and after that it is $50 monthly. This is ongoing, with no need to reapply.

Tecfidera

Program name: MS ActiveSource
Phone: (800) 456-2255
Website: www.tecfidera.com

MS ActiveSource will assist patients in the following ways:

1. Individuals with private insurance will be eligible for a $10 co-pay assistance program. There are no income limits as to who may be eligible. Individuals on Medicare who need assistance can call in to speak with a representative about other ways to receive help.
   
   
2. Individuals will need to re-enroll in the patient assistance program every year.
   
   
3. Uninsured individuals may be eligible to receive Tecfidera for free; there is an undisclosed financial criteria.

*Individuals on any insurance through a Federal program such as Medicare, Medicaid, and VA/DoD are not eligible to qualify for assistance.

Tysabri

Program name: MS ActiveSource
Phone: (800) 456-2255
Website: www.tysabri.com

MS ActiveSource will assist patients in the following ways (the guidelines are the same as for Avonex):

1. If a person has insurance (including Medicare), he or she will receive co-pay assistance. The patient's co-pay will be $10 monthly, and this program is ongoing and does not end.
   
   
2. If the person has no insurance, he or she will be helped though the Access Program. The drug will be free for two years. There is an undisclosed financial eligibility criterion. After a year and a half, the person will need to reapply.

MS ActiveSource does not pay for any costs charged by the infusion center.

*There may be an annual cap that limits the amount of assistance that you can receive over one year, based on income.

Prescription Assistance Programs for Treating Relapses

Acthar Gel

Program name: Acthar Support and Access Program (ASAP)
Phone: 1-888-435-2284
Website: www.acthar.com

Acthar Support and Access Program (ASAP) will assist patients in the following ways:

1. For uninsured or underinsured patients, there is an undisclosed financial criterion; if eligible, individuals will receive a free shipment of Acthar for the current relapse.
   
   
2. For patients with insurance, this program will assist patients in applying for co-payment assistance. Patients will be notified of the expected co-payment before Acthar shipment is made.

IV Solu-Medrol

Solu-Medrol is a high dose of corticosteroids given by intravenous (IV) infusion in an inpatient or outpatient setting. This drug is not currently patented, so multiple brands (including generic brands) are available and these do not offer patient-assistance programs. Individuals will need to check with their insurance provider regarding coverage in an inpatient or outpatient setting. Uninsured individuals should check with the facility providing the infusion to see if it offers a financial-assistance program.

*Sometimes it may be decided that pulse steroids or an oral taper of steroids are needed after an initial dose of IV Solu-Medrol.

Intravenous Immunoglobulin Replacement Therapy (IVIG):

IVIG is an experimental relapse treatment given by IV infusion. Individuals with insurance should check with their insurance provider to see if this is covered. Uninsured individuals should check with the facility providing the infusion to see if it offers a financial-assistance program.

*Advocacy for Patients with Chronic Illness is an organization that offers an IVIG resource center: http://advocacyforpatients.org/hi_ivig.html for individuals who have been prescribed IVIG and insurance denies the claim.

Plasmapheresis (Plasma Exchange):

An experimental process sometimes used when relapse treatment with steroids has not been effective. Blood is removed from the body, plasma is removed from the blood, and the remaining red and white blood cells are circulated back into the body. This procedure is performed in a medical setting. Individuals will need to check with their insurance provider to see if this is a covered procedure. Uninsured individuals should consult with the facility where they will receive plasma exchange to see if the facility offers a financial-assistance program.

Prescription Assistance Programs for MS Symptom Management

Bladder Problems

• Ditropan XL

Johnson and Johnson Patient Assistance Foundation
Phone: (800) 652-6227
Website: www.jjpaf.org/how-we-help/index.html

1. Insured (including Medicare, Medicaid, and Medicare Part D recipients) -- For individuals who fall within income guidelines and whose insurance does not cover the prescription, they must demonstrate significant financial hardship to qualify.
   
   
2. Uninsured -- Individuals who fall within the income guideline (typically 200 percent of the federal poverty level) will generally be eligible for assistance. If eligible, a person may receive the medication at no charge for up to one year, and then he or she must re-apply.

• Dibenzyline

Wellspring Pharmaceutical Patient Assistance Program
Phone: (908) 203-3791
Website: www.wellspringpharm.com/commitment-patient-assistance.html

Insured and uninsured -- Individuals must document that they have no prescription drug coverage and must meet an undisclosed eligibility criteria to qualify. If approved, a three-month supply of the medication will be shipped to their physician.

• Cipro

Bayer Healthcare Pharmaceuticals Patient Assistance Program (through RxAssist)
Phone: (866) 575-5002
Website: www.rxassist.org/

Insured and uninsured -- Individuals must document that they have no prescription drug coverage and must meet an undisclosed eligibility criteria. No one on a government-sponsored insurance program (including Medicare or Medicaid) may apply. If approved, a three-month supply of the medication will be shipped to the individual.

Cognitive Problems

• Aricept

Eisai Primary Care Assistance Program (through RxAssist)
Phone: (800) 226-2072
Website: http://us.eisai.com/product.asp?ID=168

Insured or uninsured (including Medicare) -- An individual must document that he or she has no prescription drug coverage and must fall within 200 percent of the federal poverty level to qualify. If approved, a three-month supply of the medication will be shipped to the person's physician. Individuals must re-apply for the program every 12 months.

Depression

• Zoloft
• Effexor

Please see Pfizer Connection to Care at the end of this listing.

• Celexa
• Lexapro

Please see Forest Pharmaceuticals Patient Assistance Program at the end of this listing.

• Prozac

Please see Lilly Cares and LillyMedicareAnswers at the end of this listing.

• Wellbutrin

Phone: (800) 548-5100, option 1
Website: www.wellbutrinxl.com

Patient support programs include the following:

Co-Pay Savings Program - Individuals who are insured as well as those who are uninsured (excluding any government-sponsored insurance such as Medicaid and Medicare) may print a coupon to pay an initial $4 toward the cost of the medication. The coupon then pays up to the next $50 of the medication costs. The coupon can be used up to 12 times.

Fatigue

• Provigil
• Nuvigil

ChephalonCares® Foundation
Phone: (877) 237-4881
Website: www.cephalon.com/cephaloncares-foundation.html

Uninsured -- Individuals within 300 percent of the federal poverty level and approved through the program will receive the medication free of charge.

Pain

• Lyrica
• Neurontin
• Dilantin
• Cytotec

Please see Pfizer Connection to Care at the end of this listing.

• Depakote

Partnership for Prescription Assistance Phone: (888) 477-2669
Website: www.pparx.org

1. Insured -- Individuals pay the first $5 of their co-payment for a qualified prescription; the discount card covers up to the next $75 off of the remaining co-pay expenses. The discount card can be used up to two times per month.
   
   
2. Uninsured or self pay -- Individuals may print a coupon to pay the first $5 of their prescription and the coupon will pay up to the next $75 of the remaining medication costs.

Pseudobulbar Affect

• Nuedexta

Phone: (855) 4NUEDEX (468-3339)
Website: www.nuedexta.com

Patient support programs include the following:

1. Private insurance -- Individuals who are within 200 percent of the federal poverty level may qualify for the co-pay assistance program. This will reduce their co-pay to no more than $30 per medication refill.
   
   
2. Medicare Part D -- Individuals may be able to qualify for co-payment through an assistance program.
   
   
3. No insurance or no prescription coverage -- Individuals who are within 200 percent of the federal poverty level may be able to receive the medication for free through a voucher program.

Please note that patients must re-apply for prescription assistance each year.

Sexual Dysfunction

• Viagra

Please see Pfizer Connection to Care at the end of this listing.

• Cialis

Please see Lilly Cares and LillyMedicareAnswers at the end of this listing.

Spasticity

• Botox

Phone: (800) 44-Botox (442-6869), option 4
Website: www.botoxreimbursement.us/pap.aspx

Patient support programs include the following:

1. Botox Partnership for Access - Individuals with private insurance (excluding Medicaid, Medicare, and any other government healthcare program) may receive up to $100 (on a pre-paid card) per Botox treatment to assist with co-pay fees. This program only applies if an individual's insurance will cover the procedure.
   
   
2. Botox Prescription Assistance - Individuals who are uninsured or whose insurance does not cover Botox may qualify if they fall within 300 percent of the federal poverty level. If approved, the medication would be shipped for free to their doctor's office. Individuals must use the request form to obtain a new shipment every three months. Please note that this program only covers the cost of the Botox medication for eligible individuals and does not cover any other fees associated with the injection, which may be billed by the physician.

• Neurontin

Please see Pfizer Connection to Care at the end of this listing.

Vertigo/Dizziness

• Antivert

Please see Pfizer Connection to Care at the end of this listing.

Pharmaceutical Company Programs for More than One Medication

Forest Pharmaceuticals Patient Assistance Program

Phone: (800) 851-0758
Website: www.forestpharm.com/pap/

• Celexa (depression)
• Lexapro (depression)

1. Insured and uninsured -- Individuals who meet the undisclosed income guidelines will be shipped a three-month supply of their medication at no charge. If an individual still needs assistance after three months, he or she must re-apply.
   
   
2. Medicare Part D -- In most circumstances, people with Medicare Part D must apply for and be denied "Low Income Subsidy" (LIS) by the Social Security Administration before qualifying.

Lilly Cares and LillyMedicareAnswers

• Cialis (sexual dysfunction)
• Prozac (depression)

1. Lilly Cares -- Individuals who are uninsured or have no prescription drug coverage may qualify if their income falls within 300 percent of the federal poverty level. A 120-day supply of the medicine is shipped out and refills are available for one year.
   Phone: (800) 545-6962
   Website: www.lillytruassist.com/Pages/AboutLillyCares.aspx
   
   
2. LillyMedicareAnswers -- Individuals must be enrolled in a Medicare Part D program and must be denied or otherwise ineligible for the "Low Income Subsidy" (LIS) offered through the Social Security Administration (SSA). Income must fall within 300 percent of the federal poverty level to qualify.
   Phone: (877) 795-4559
   Website: www.lillytruassist.com/pages/AboutLMCA.aspx

Pfizer Connection to Care

Phone: (866) 706-2400
Website: www.pfizerhelpfulanswers.com/pages/programs/ProgramDetails.aspx?p=2

• Antivert (vertigo)
• Cytotec (pain)
• Dilantin (pain)
• Effexor (depression)
• Lyrica (pain)
• Neurontin (spasticity/pain)
• Viagra (sexual dysfunction)
• Zoloft (depression)

1. Prescription coverage -- Income must fall within 200 percent of the federal poverty level to qualify. For individuals with serious financial hardship (where a person cannot afford his or her coinsurance, or has been denied coverage for the medication), hardship assistance may be requested. If approved for the program, individuals will receive the medication at no cost until the end of the current calendar year.
   
   
2. No prescription coverage -- An individual's income must fall within 200 percent of the federal poverty level to qualify. If eligible, the medication is mailed to the prescribing physician's office (excluding Lyrica, which is sent to the patient directly).