Many times members of the bleeding disorders community run into problems with insurance coverage, either no insurance or a gap in insurance coverage, but still need factor product. The major producers of factor products have programs that can offer help during these times. Here is a rundown on the patient assistance programs of the factor companies.
Bayer Healthcare Pharmaceuticals – Factor Solutions Programs
Web Site: http://www.rxassist.org/Search/Prog_Details.cfm?program_Id=461&PD_Id=1989&Drug_Id=2641&Company_Id=7&search_type=2&CFID=8682774&CFTOKEN=68667953
Eligibility: Patient must meet the program's financial criteria. Patient must be US citizen or legal resident of the United States. Medicaid spend-down patients are not eligible.
Income Requirements: Yes.
Program Requirements: A filled-out application, proof of income, proof that insurance coverage has lapsed, a factor prescription with the doctor’s signature.
Gap Coverage application: http://www.rxassist.org/plus/out/8682774_68667953/bayer_kogenate-GAP-frm.pdf
What you can get: A one-month supply of product shipped to you or to your provider. Re-Application Policy and Refill Policy are not published.
Patient Assistance Program: Patients with no insurance who require assistance for Kogenate® FS treatment, or patients who need assistance because their current insurance policy will not cover Kogenate® FS, will be considered for the program.
Patients should call the Bayer Reimbursement HELPline at 800-288-8374 to see if they qualify for the Kogenate FS PAP. A Program Analyst will assess each patient's specific case by walking him through a step-by-step prescreening process. During this process, the Program Analyst will examine all possibilities for that patient's treatment coverage, such as state prescription plans, Medicaid, or community programs and provide any information that is uncovered.
CSL Behring – CSL Behring Assurance Program
Web Site: https://www.cslbehringassurance.com/cslbehring_enu/start.swe?SWECmd=Start&SWEHo=www.cslbehringassurance.com
GAP Program Eligibility: Anyone using one of the following CSL Behring products can enroll in the CSL Behring Assurance Program: Factor products, Immune globulin therapies, Alpha-1 therapy, C-1 Inhibitors
Income Requirements: No
Program Requirements: At the time of enrollment and throughout your participation in the CSL Behring Assurance Program, you must be a US resident and have third-party, private coverage as your primary insurance. Third-party, private coverage includes, but is not limited to, Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans and Fee-for-Service plans administered by private companies. Third-party, private coverage does not include plans from which funds for payment of claims originate from federal, state, and/or local government budgets.
What you can get: You will earn an Award Certificate for every 3 consecutive months you use an eligible CSL Behring product. This means you can earn up to 4 months of complimentary product each year you are enrolled in the Program. You can also earn bonus certificates and exchange competitor certificates for CSL Behring Assurance Certificates.
Patient Assistance Program: Upon reviewing the case with one of our staff members and determining that assistance is warranted, the CSL Behring Department of Reimbursement Services will send a Program Qualification Form to be completed by both you and your attending physician. Once the necessary forms have been completed and returned to our office, the CSL Behring Reimbursement Services and Medical Affairs Departments will determine eligibility for participation in our program.
Call the CSL Behring Reimbursement Services Department at 1-800-676-4266 between the hours of 8:00 am – 5:00 pm (ET), Monday through Friday to receive enrollment forms or to ask any questions about the program.
Program Requirements: A completed Patient Assistance Qualification Form; the brand name prescription for medication; a letter from the physician with the following patient information: Name, Complete mailing address, Date of birth, Social security number, Diagnosis, Insurance status, Insurance synopsis (reason for need and description of other attempts made to access alternate coverage).
What you can get: Qualified patients may receive up to a 3-month supply of a CSL Behring product. At the end of 3 months, the patient’s eligibility is re-evaluated for continued participation in the program if needed.
Patient Care Program
Web Site: http://www.grifolspatientcare.com/
Grifols Assurance for Patients (GAP) Program
Eligibility: For patients with a lapse in private insurance who have been treated with a Grifols product for three contiguous months while on a non-government health insurance plan.
Income Requirements: No.
Program Requirements: Complete an application. Supply a prescription and letter of medical necessity with physician’s signature. Must be a US citizen or have legal residency.
Application: Call 888-325-8579 and select Option 3 or download at: http://www.grifolspatientcare.com/GAP%20Enrollment%20form.pdf
Grifols Patient Assistance (GPA) Program
Eligibility: For patients without insurance coverage and in need to factor product.
Income Requirements: Yes, income not to exceed 250% of Federal poverty level.
Program Requirements: Complete an application. Patient must not be eligible for any state or federally funded healthcare. Must be a US citizen or have legal residency.
Application: Call 888-325-8579 and select Option 3 or download at: http://www.grifolspatientcare.com/GPAP%20Application.pdf
Novo Nordisk Patient Assistance Programs
Web Site: http://www.novonordisk-us.com/documents/article_page/document/Patient_Assistance_Hemo.asp
Eligibility: For patients who are uninsured, who have insurance but have been denied with no appeal, for those with pending status but not yet eligible, and for those within $50,000 of their lifetime cap.
Income Requirements: No.
Program Requirements: A filled-out application.
What you can get: You may qualify for up to 6 months or 300 mg of NovoSeven® RT FREE OF CHARGE as you find additional coverage. No coupons or certificates are necessary.
Application: Call 877-668-6777 to request an application or download form at: http://www.novosevenrt.com/pdfs/SevenASSIST-Patient-Form.pdf.
Eligibility: People with hemophilia A or B with inhibitors, acquired hemophilia, or congenital Factor VII deficiency to address the needs that go beyond providing factor. There are no points or coupons needed based on prior use on NovoSeven. Financial assistance with insurance, education and medical expenses for those with hemophilia with inhibitors. This includes dental expenses, transportation cost, & college tuition & adult education expenses
Income Requirements: Yes
Program Requirements: A filled-out application and physician’s diagnosis and signature.
What you can get: Depends on need.
Application: Call 877-668-6777 and request an application.
Octapharma Trial Offer
Eligibility: For physicians wanting to start their patients on wilate Von Willebrand Factor/Coagulation Factor VIII (Human). Most patients are eligible for a free one-month shipment.
Program Requirements: A filled-out application and physician’s signature sent to this fax number (877) 920-1115.
What you can get: One month supply of wilate Von Willebrand Factor/Coagulation Factor VIII (Human)
Application: Call 800-554-4440 and request an application.
Pfizer/Wyeth – Wyeth Factor Resource Program
Web Site: http://www.hemophiliavillage.com/resources-support/insurance-support/default.aspx
Eligibility: Patients are eligible if they have received a new prescription for XYNTHA or BeneFix. Previous use of XYNTHA or BeneFix is not required to qualify for patient assistance. In order to be eligible, you must: Have no prescription coverage; meet specific income guidelines; live in the United States, Puerto Rico, or the US Virgin Islands; be receiving treatment from a US-licensed physician (For Puerto Rico, patients must be treated by a Puerto Rico-licensed physician.)
Patients with prescription coverage who demonstrate significant financial hardship can apply for Hardship Assistance through the RSVP program. If eligible, patients can access XYNTHA or BeneFix for free. An RSVP representative will help determine a patient's eligibility.
Income Requirements: Yes.
Program Requirements: Qualifying for free XYNTHA or BeneFix is based on your need and eligibility. For assistance, please call 1-888-327-7787. A Pfizer RSVP representative will determine your eligibility as well as help you through the enrollment process, benefits verification, and product fulfillment.
When you call, be ready to provide: Name, address, and phone number of prescribing physician or facility; physician's NPI (National Provider Identifier); taxpayer ID number of facility; patient information, including Social Security number†; patient insurance information including policy, ID number, and group number; patient treatment, diagnosis, and supporting documentation. †Social Security number required for insured patients if needed to verify benefits.
No paperwork is required for immediate qualification.
What you can get: You can receive the XYNTHA or BeneFix you need (short-term 30-day supply) while we confirm your eligibility. Proof of income documentation and a completed application are required within 30 days.