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Navigating Patient Assistance Programs

Patient Assistance Programs
With the uncertainty of healthcare, many in the bleeding disorders community are concerned about the future of cost and access to factor products. Co-payments and out-of-pocket expenses can be devastating on a family’s budget. Assistance programs can provide a source of relief.

Note: The programs and services listed below are independent of HFA and provided as a courtesy to our community families.  Programs change frequently and we do our best to keep this resource up-to-date. Please contact these organizations directly to inquire about their support.

Factor Co-Pay Programs

 
Company/Organization Co-pay/Co-insurance Program Name & Contact Information Limit Total Notes:
Aptevo Therapeutics IXINITY Savings Program

1-855-494-6489

$12,000 • Must have a valid prescription for IXINITY.

• Must have commercial insurance.

• No monthly limits unless limit total is reached.

• No income requirements.

• Co-pay program can be used retroactively for up to 12 months.

Bayer Bayer Access Solutions

Kogenate FS Co-pay/Co-insurance Program

1-800-288-8374

$12,000 • Must have a diagnosis of hemophilia A.

• Must have a private health insurance plan.

• No income requirements.

• Must first contact Bayer Access Solutions.

Bioverativ ALPROLIX Co-pay Program

1-855-692-5776

 

ELOCTATE Co-pay Program

1-855-693-5628

$12,000 • Available to those who use ALPROLIX or ELOCTATE.

• Must have commercial insurance.

• Must be treated by licensed doctor in US or Puerto Rico

• US prescriber and pharmacy required.

• No income requirements or caps.

• Must call number provided  for ALPROLIX to enroll or request additional information.

• Enrollment form available for ELOCTATE via link provided

• Not responsible for costs associated with administration of therapy, such as office visits, infusion costs, or other professional services.

Caring Voice Coalition
(CVC)
Factor XIII deficiency program

1-888-267-1440

$8,000 • Must be diagnosed with one of the specific diagnoses that CVC supports.

• Must be prescribed an FDA-approved therapy to treat the CVC-supported

diagnosis (must be specifically indicated; no off-label).

• Have an active prescription insurance coverage which pays for a portion of

the prescribed FDA-approved therapy (does not qualify if prescription has

ever been denied).

• Income must fall at or below 450% of the Federal Poverty Level based on

household size and income.

• Must be a US resident.

• Other services offered are financial assistance, non-financial services

(insurance education and counseling) and disability services.

CSL Behring MySource Cost-Share Program

1-800-676-4266

$12,000 for Afstyla, Idelvion, Helixate, or Humate • Must take a CSL Behring eligible product (on-label) for the treatment of

von Willebrand disease or hemophilia.

• Must currently have active commercial insurance (federal or state insurance

programs are not eligible).

• Co-pay enrollment requests requires patient consent.

• Only products purchased from Specialty Pharmacies (SP), Hemophilia

Treatment Centers (HTC) and Outpatient Hospital services will be eligible.

• Co-pay program is not retroactive and cannot be transferred. Exception

requests may be submitted for consideration.

• Must be a US resident.

• No financial restrictions apply.

• Obtain specific product enrollment form by contacting CSL Behring My Source Care Coordinator at the number listed.

Program benefit DOES NOT apply toward out-of-pocket costs for:

• Physician office visit co-pays.

• Infusion-related costs or ancillary supplies.

• Insurance premiums.

Grifols Factors for Health Patient Support Program

1-844-693-2286
(844-MY-FACTOR)

$6,000 ($500

each month

max)

• Pay as little as $0 for ALPHANATE and Alphanine SD.

• No monthly or annual maximums. Individual claims exceeding $2000 will be reviewed for network eligibility.  Claims that are in-network will be approved, but those out-of-network may be denied.

• Prescription is covered up to the patient’s annual out of pocket (OOP)maximum. The general OOP maximum limits under the affordable care act are $6850 (self-only coverage) and $13,700 (coverage for more than self only).

• No waiting period; patients may use the offer as soon as they enroll.

• No income requirements.

• Annual program enrollment is required.

• Must have commercial insurance.

• Patients must have a valid ALPHANATE or AlphaNine SD prescription.

• Restrictions apply.

• Helps to cover co-pay and co-insurance costs for ALPHANATE and AlphaNine SD only. It does not cover costs related to physician visits and is not for inpatient use.

Kedrion Biopharma No co-pay program currently available.

1-855-353-7466

N/A N/A
Novo Nordisk Co-pay Assistance Program

1-844-668-6732

$12,000 • Have hemophilia A and have been prescribed an appropriate Novo Nordisk factor treatment; OR

• Have congenital hemophilia A or B with an inhibitor, congenital FVII deficiency, Glanzmann’s thrombasthenia with refractoriness to platelet transfusions, or acquired hemophilia and have been prescribed an appropriate Novo Nordisk factor treatment; OR

• Have FXIII A-subunit deficiency and have been prescribed an appropriate Novo Nordisk factor treatment; AND

• Have private/commercial insurance only (state and federal funded programs ineligible)

Octapharma Octapharma Co-Pay Program

1-800-554-4440

Up to $12,000

for NUWIQ per

year

Up to $6,000 for

Wilate per year

NUWIQ CoPay Program

Wilate CoPay Program

• No income requirements

• Only applies to patients with private commercial insurance

• Must have a prescription for NUWIQ and/or Wilate

• Other restrictions may apply

Pfizer Pfizer Factor Savings Program

1-888-240-9040

$12,000 • Provides co-pay and co-insurance assistance for a Pfizer factor product.

• Patient financial responsibility of $10 per month.

• No financial eligibility requirements.

• Must be commercially insured with health insurance that covers factor.

• Medicare/Medicaid beneficiaries are not eligible.

Shire Shire’s Hemophilia Co-pay Program

1-888-BAX-8379
(1-888-229-8379)

$12,000 • Enrollment can be submitted online or over the phone.

• Must have commercial insurance.

• Must use eligible Shire hemophilia products.

• Eligible patients with private insurance receive up to $12,000 every 12

months for medication-related co-payment/co-insurance with retroactive

assistance for a date of service within 120 days prior to their co-pay

activation date.

• No income requirements.

• Adynovate follows FDA guidelines (approved for 12 years of age or older).

• Program is only valid for residents of the United States, excluding Puerto Rico and other U.S. territories.

*HFA makes every attempt to provide accurate information regarding patient assistance programs and resources. However, since program policies often change, please contact the manufacturer directly for the most updated information. This chart has been updated on July 7, 2017.

For those in the bleeding disorder community who are uninsured, underinsured, or experiencing lapses in insurance coverage, there are also assistance programs to help families facing financial strain get access to factor products.

 

Product Assistance Programs

Company/Organization Product Assistance Program Name & Contact Information
Aptevo Therapeutics IXINITY Patient Assistance Program: For patients who are uninsured or experiencing a lapse in coverage to access treatment. Must meet income requirements. 1-855-494-6489
Akorn Pharmaceuticals Patient Assistance Program: This needs-based program assists patients in accessing Amicar. Programs include copay assistance for patients with commercial insurance coverage and a need based support program for those patients without commercial insurance. These are newly created programs to support your access to the product and reduce copay obligation automatically at participating pharmacies. Click on the link above to locate programs. 1-844-202-5909
Bayer GAP Coverage Program: Patients who are unemployed or have a loss or lapse in private insurance coverage; connects you to temporary insurance coverage.

Patient Assistance Program: Patients who do not have insurance, lack third-party coverage, or have pending Medicaid approval may be eligible to receive Kogenate FS. 1-800-288-8374

Bioverativ Factor Access Program: Patients using ALPROLIX or ELOCTATE who have no prescription coverage, are facing a gap in coverage, or have reached their maximum insurance coverage limit, may be eligible to receive product for free. Other restrictions may apply.

For ALPROLIX 1-855-692-5776
For ELOCTATE 1-855-693-5628

CSL Behring Patient Assistance Program: To be eligible, patients must be underinsured or uninsured. When enrolled, must actively be seeking insurance.

Assurance Program: Must currently have private health insurance coverage; this is a certificate program that helps with potential future lapses in private health insurance plans. 1-800-676-4266

Grifols Grifols Patient Assistancec Program: This program is for patients using ALPHANATE, AlphaNine SD or ProfilNINE who are uninsured or experiencing a temporary lapse of insurance coverage. 1-844-MYFACTOR (1-844-693-2286)
Kedrion Biopharma No program currently available 1-855-353-7466
Novo Nordisk Novo Nordisk Product Assistance Program: Provides medication to qualifying applicants at no charge. Eligible patients must have been prescribed a Novo Nordisk product for an indicated condition (check the website for a complete list of eligible conditions), have no insurance coverage, and actively be seeking insurance coverage. Patient must be a documented US resident or on a path to documented status with reasonable likelihood of attaining it. Federal government insurance programs are ineligible. 1-844-668-6732
Octapharma NUWIQ Free Trial Program allows for up to six (6) doses, or 20,000 IUs, of NUWIQ. A prescription for NUWIQ is required and other restrictions may apply.

 

Wilate Free Trial Program allows for up to 5,000 IUs for Wilate. A prescription for Wilate is required and other restrictions may apply.

1-800-554-4440

Phizer Pfizer Patient Assistance Program: Patients must meet income guidelines, which vary by product and household size; have no prescription coverage, or not enough coverage, to pay for their medicine; live in the United States or US territories; and be treated by a health care professional licensed in US/PR. 1-844-989-PATH (7284)
Shire Shire Patient Assistance Program: Provides uninsured and financially-eligible patients free product for eligible Shire’s hemophilia products.
1-888-229-8379

 

Hepatitis C Virus Co-Pay & Patient Assistance Programs

Program Name & Contact Information Limit Total Notes:
AbbVie Co-pay Assistance

 1-800-222-6885

 

Viekira Pak Co-pay Card

1-844-277-6233

 

Call for further details

 

·    Eligible patients may receive Viekira Pak for as little as $5 with co-pay card.

·    Must have commercial prescription insurance coverage for an FDA-approved 
AbbVie product.

·    Co-pay assistance is not available to patients receiving prescription 
reimbursement under any federal, state, or government funded programs.

·    Patients may not seek reimbursement for value received from the AbbVie HCV Co-pay Program from any third-party payers.

 

AbbVie Co-pay Assistance

 

Moderiba Co-pay Card

 

1-800-222-6885

 

Call for further details

 

·    Application must be submitted to consider the following: family size, medica- tion being taken, other special circumstances.

·    Eligible patients may receive Moderiba for as little as $5 with co-pay card.

·    Must have commercial insurance coverage.

·    Co-pay assistance is not available to patients receiving prescription reim- 
bursement under any federal, state, or government funded programs.

 

Bristol-Myers Squibb (BMS) Co-pay Assistance

 

Patient Support CONNECT Co-pay Program

 

1-844-442-6663

 

For use of Daklinza up to a maximum benefit of $5,000 per 28-day supply of 30mg or 60mg OR up to a maximum benefit of $10,000 per 28-day supply of 90mg

 

·    You are insured by commercial insurance and your insurance coverage does not cover the full cost of your prescription; that is, you have a co-pay obligation.

·    You do not have prescription insurance coverage through a state or federal healthcare program, including but not limited to Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA) or Department of Defense (DOD) programs. Patients who move from commercial to a state or federal healthcare program will no longer be eligible.

·    You are 18 years of age or older.

·    You are a resident of the US or Puerto Rico.

 

Genentech/Roche Product Assistance

 

Genentech Access Solutions

(Umbrella for product inquiries) 1-866-422-2377

 

Genentech Access to Care Foundation (for patients who do not have insurance, or have high co-pay)

1-888-941-3331

 

Call for further details for product specific guidelines

 

·     Assists eligible patients with their Genentech medicines free of charge.

·     Must be prescribed a Genentech medicine.

·     Certain financial and medical criteria must also be met.

 

Gilead Co-pay Assistance

 

Harvoni Support Path

 

1-855-769-7284

 

The HARVONI Co- pay Coupon Program will cover the out-of-pocket costs of your HARVONI prescriptions after you pay the first $5 per prescription fill, up to a maximum of 25% of the catalog price of a 12-week regimen of HARVONI. The offer is valid for six (6) months from the time of first redemption.

 

·    Eligible residents of the US, Puerto Rico, or US territories at participating eligible retail, specialty, or mail-order pharmacies in the US, Puerto Rico, or US territories.

·    Coupon not valid for prescriptions eligible for reimbursement in whole or part by federal or state health care programs (e.g., Medicaid/Medicare) or for commercial health coverage that will cover entire cost of prescription.

·    Allowable to use full value up front.

 

Gilead Product Assistance

 

Support Path Patient Assistance Program

 

1-855-769-7284

 

Call for further details ·     Provides Sovaldi or Harvoni or Epclusa at no charge for eligible patients with no insurance coverage.
Good Days from Chronic Disease Fund

 

Patient Assistance

 

1-877-968-7233

Call for further details ·     Provides assistance with out-of-pocket costs for hepatitis C virus prescriptions.

·    Patients must have valid medical insurance coverage. Please note, patients who are applying for co-payment assistance must have at least 50% insurance cover- 
age or more to be eligible for co-payment assistance, excluding deductibles.

·    Patients must have been prescribed a medication that is part of the Good 
Days formulary.

·    Patients must meet our annual household income criteria.

·    (Note: Program may open and close throughout the year depending on funding.)

 

HealthWell Foundation

Co-pay Assistance

 

HealthWell Foundation Resource List

1-800-675-8416

 

Up to $30,000 •    Must currently receive treatment for Hepatitis C.

•    Must have insurance (private, federal, or state plans acceptable) that covers 
medication.

•    Assists individuals with incomes up to 500% of the Federal Poverty Level. 
Household number and cost of living are also considered.

•    Must receive treatment in the US.

 

Kadmon Pharmaceuticals Co-pay Assistance

1 -888 668-3393

Ribasphere RipaPak Co-pay Savings Card

 

1-877-377-7862

Eligible patients may save up to $150 toward each monthly Ribasphere RipaPak co-pay for up to 18 fills •    Self-pay patients and most commercially insured patients are eligible.

•    Patients residing in Massachusetts and Puerto Rico are not eligible.

•    Patients covered by Medicare, Medicaid, TRICARE, or other federal or state 
healthcare programs are not eligible.

•    Patients must be five (5) years of age or older to participate. A parent or legal 
guardian must enroll on behalf of patients under 18 years of age.

•    The Co-pay Savings Card is valid for Ribasphere RibaPak product only. Only one (1) Co-pay Savings Card is required per patient.

Janssen/Johnson & Johnson Olysio Co-pay Assistance

 

Olysio Savings Program

 

1-855-565-9746

Pay no more than
$5 per fill. $50,000 annual maximum benefit or 12 months from card activation date, whichever comes first. ·     Must have commercial insurance.

·     Not valid for patients enrolled in Medicare or Medicaid.

·     Offer good only in the US and Puerto Rico.

 

Janssen/Johnson & Johnson Olysio Product Assistance

 

Johnson & Johnson Patient Assistance Foundation

 

1-800-652-6227

Call for further details ·    Provides Olysio for patients without public or private insurance or prescription drug coverage.

·    Must live in the US or US Territory and be treated as an outpatient by a licensed US doctor.

·    Must meet income eligibility guidelines.

Patient Access Network (PAN) Foundation

 

1-866-316-7263

$7,200 per year •    Patient must be getting treatment for the disease named in the assistance program to which he or she is applying.

•    Patient must be insured.

•    Patient’s medication must be listed on PAN’s list of covered medications. For 
full list, visit PAN’s website.

•    Patient must reside, and receive treatment in, the US. US citizenship is not a 
requirement.

•    Patient’s income must fall at or below 500% of Federal Poverty Level.

Patient Advocate Foundation

Co-pay Assistance

 

Co-pay Relief Hepatitis C Program

 

1-866-512-3861

$24,000 per year •    Patient should be insured and insurance must cover the medication for which patient seeks assistance.

•    Patient must have a confirmed diagnosis of hepatitis C.

•    Patient must reside and receive treatment in the US.

•    Patient’s income must fall below 400% of the Federal Poverty Guideline with consideration of the Cost of Living and the number in the household.

 

Additional Resources

Program Name

Program Description

Assurance Wireless

1-888-321-5880

Provides a free cell phone and limited number of free minutes to income-qualifying households. Not available in every state, please check website or call for state specific information.
AT&T Mobility Lifeline Service

1-800-377-9450

AT&T Mobility Lifeline Service Provides discounted cell phone service to income-eligible customers. Not available in every state. Call for more information. Certain Tribal Lands also eligible.
Colburn-Keenan Foundation

1-800-966-2431

Provides financial assistance programs to individuals and families living with chronic conditions, with priority placed on those living with bleeding disorders.
Healthcare Hospitality Network

1-800-542-9730

Provides lodging and support services to patients, families and loved ones who are receiving medical treatment away from home.
Internet Essentials from Comcast

1-855-847-3356

Provides low-cost internet service and computers for income-eligible households.

 

Needy Meds

1-800-503-6897

Provides assistance in accessing patient assistance programs for medications and health care costs.
Novo Nordisk

NovoSecure

1-844-668-6732

NovoSecure enrollees can apply for a variety of programs, including competitive scholarships, life coaching with HeroPath, career counseling, and insurance support. Eligibility for programs vary. Must have hemophilia A, hemophilia A or B with inhibitors, factor VII deficiency, factor XIII deficiency, acquired hemophilia, or Glanzmann’s Thrombasthenia to apply. Novo Nordisk product usage is not an eligibility requirement.
Patient Advocate Foundation

1-800-532-5274

Provides case management and assistance in accessing health insurance. Co-pay assistance programs are available.
Patient Services, Inc

1-800-366-7741

Legal Support Hotline:

1-877-851-9065

Assistance Programs for Commercial Insured Patients

Patients with commercial insurance (i.e. – Individual, Group, Marketplace/Exchange, COBRA) are eligible to receive financial support regardless of product, with a “first come; first serve” policy, if the commercial program is adequately funded and they are deemed eligible for assistance. If approved for assistance, patients can receive up to $11,000.00 per year in premium support.

 

Assistance Programs for Public Insured Patients

Patients with public insurance (i.e. – All forms of Medicare, Medicaid, Supplemental, Medigap, etc.) are eligible to receive financial support regardless of product, with a “first come; first serve” policy, if the public program is adequately funded and they are deemed eligible for assistance. If approved for assistance, patients can receive up to $11,000.00 per year in premium support.

Rx Hope A web-based information resource to help low-income US residents access patient assistance programs.
Rx Outreach

1-888-RXO-1234 (1-888-796-1234)

A patient assistance program that provides discounts on prescription drugs.

 

Safelink Wireless

1-800-723-3546

Provides a free cell phone and limited number of free minutes to income-qualifying households. Not available in every state, please check website or call for state specific information.
Silver Cross

1-844-352-7677

Provides assistance in accessing recycled and new healthcare equipment.

 

The Wheelchair Foundation

1-877-378-3839

Provides free wheelchairs for individuals without the means to obtain one.

 

United Healthcare Children’s Foundation

1-855-698-4223

Provides medical grants to help children gain access to health-related services not covered, or not fully covered, by a commercial health insurance plan. Do not need to have United Healthcare to be eligible.
United Way 211

Dial 211

Provides free and confidential information and referrals to local services including housing, food, employment, healthcare, counseling, and more. Check the website or call your local United Way to see if your state offers this service.
Verizon Wireless Lifeline Program

1-800-417-3849

Provides discounted cell phone service to income-eligible customers and residents of Tribal Lands. Not available in every state, check website or call for state specific information.

 

Assisting and Advocating for the Bleeding Disorders Community