Patient Assistance and Co-Pay Programs for Viral Hepatitis Drugs

Introduction

Are you uninsured? If you do have health coverage, are your prescription co-pays or other co-insurance costs prohibitively expensive? Or does your health plan come with high medication deductibles that you can't afford? Help may be available from pharmaceutical companies in the form of patient assistance programs (PAPs) and co-pay programs.

In recent years, the Fair Pricing Coalition (FPC) has been working closely with the pharmaceutical industry to streamline access to co-pay
programs and PAPs for people living with viral hepatitis. The FPC has negotiated co-pay programs with virtually every major hepatitis drug
manufacturer. Below is a list of co-pay and patient assistance programs for hepatitis C, including contact information for these programs. This page will be updated as new treatments are released and in the event that these programs evolve over time.

Different pharmaceutical company programs have different eligibility criteria based on the federal poverty level (FPL). The 2013 FPL income for an individual is $11,490. The figure is adjusted based on family or household size. A complete table is available here. Unless otherwise stated, companies ask for verification of income, usually in the form of a federal income tax return. Companies also generally consider household income, meaning that a married couple that files joint taxes will be judged on their combined income. People who file individual income tax returns will only have their individual income considered. If you are told you are ineligible for assistance, this does not mean there is still no chance for you; you can always appeal and hope to have the decision reversed.

CO-PAY PROGRAMS

These programs offer assistance to people with private insurance for the co-payments or coinsurance costs required to obtain hepatitis
C drugs at the pharmacy.

Gilead Sciences
Drugs covered: Harvoni
(sofosbuvir)/Lepidisvir)
Contact Information: 855-769-7284
or www.MySupportPath.com
Program Details:Support
The Sovaldi and Harvoni Copay Coupon Program can bring copays down to $5 in most
cases for those who qualify. Financial aid for as much as $16,000 is
also available to go toward prescription deductibles and coinsurance
obligations.  The program is open to those with a maximum
household income of $100,000 for up to a family of three, and 500
percent of federal poverty level for families with four or more members.
Johnson & Johnson/Janssen
Drugs covered: Olysio
(simeprevir)
Contact Information: 855-5-OLYSIO
or www.olysio.com
Program Details:The
Janssen Therapeutics Patient Savings program assists those who qualify
by reducing their copays or coinsurance for Olysio to no more than $25
a month. This translates to a total of $75 for the three-month regimen
of the drug in most cases. The maximum financial assistance is $25,000
for the 12-month period after you qualify, or until you've filled three
bottles of Olysio, whichever comes first. To qualify, your household
income must be under 500 percent of the federal poverty level, although
you can appeal for total coverage if your income is higher. This offer
is not available for those enrolled in Medicare or Medicaid.
Merck & Co.
Drugs covered: PegIntron
and Victrelis
Contact Information: 866-939-4372
or www.victrelis.com and www.pegintron.com
Program Details: Victrelis:
People can print out a card at www.victrelis.com and at merck-cares.comwhich
offers eligible patients savings of up to 20 percent of the total cost
of each Victrelis prescription, on up to 12 prescriptions (which would
be a full 44 weeks of treatment for those who need it for that
duration). PegIntron: People can print out a card at www.pegintron.com and at merck-cares.com,
which offers eligible patients up to $200 savings on their copayment
for each Pegintron prescription, on up to 12 prescriptions.

These programs offer free hepatitis C drugs to lower-income people with who are uninsured or underinsured and who do not qualify for insurance programs such as Medicaid or Medicare. PAP PROGRAMS

Hepatitis C Virus (HCV)

Genentech/Roche
Drugs covered: Pegasys
and Copegus
Contact Information: 888-941-3331
or www.pegasysaccesssolutions.com.
Program Details: The PAP
is for people who do not qualify for other assistance or health
insurance programs and is limited by income. Most programs have limits
based on the total household income compared to established federal
poverty levels. Generally, programs will accept appeals for special
circumstances if a person does not initially qualify and is turned down.
Gilead Sciences
Drugs covered: Sovaldi and Harvoni
(sofosbuvir/Lepidisvir)
Contact Information: 855-769-7284
or www.MySupportPath.com.
Program Details: Called
Support Path, Gilead's program may provide Sovaldi coverage for free to
those with a maximum household income of $100,000 for up to a family of
three, and 500 percent of federal poverty level for families with four
or more members. You can also contact Support Path for assistance
finding other sources of health coverage, such as through Medicaid,
Medicare or the new health exchanges available through Obamacare.
Johnson & Johnson
Drugs covered: Procrit*,
Olysio (simeprevir)
Contact Information: 800-652-6227
or www.jjpaf.org.
Program Details:The
Johnson & Johnson Patient Assistance Foundation will provide
free coverage of Olysio to those who qualify. The income limit is 500
percent of the federal poverty level, although you can appeal if your
income is higher than that. For Procrit, the income cap is 400 percent
FPL.
*Procrit
is a treatment for anemia—a side effect commonly caused by the drug
ribavirin, which is a component of many hepatitis C regimens.
Merck & Co.
Drugs covered: Pegintron
and Victrelis
Contact Information: 866-363-6379
or www.merckhelps.com.
Program Details: The ACT
Program can help you answer questions related to insurance coverage and
reimbursement. Program Specialists can also help you apply for the PAP.
The PAP is for people who do not qualify for other assistance or health
insurance programs and is limited by income. Most programs have limits
based on the total household income compared to established federal
poverty levels. Generally the program will accept appeals for special
circumstances if a person does not initially qualify and is turned
down, provided they fall within the 500% FPL income eligibility
requirement.
Vertex Pharmaceuticals
Drugs covered: Incivek
Contact Information: 855-837-8394
or www.incivek.com
Program Details: The PAP
is for people who do not qualify for other assistance or health
insurance programs and is limited by income. Most programs have limits
based on the total household income compared to established federal
poverty levels. The Incivek PAP helps people whose household income is
less than $100,000 per year. Generally, programs will accept appeals
for special circumstances if a person does not initially qualify and is
turned down.

The above is based on a document originally produced by the Fair
Pricing Coalition, an ad hoc group of activists who advocate
with the pharmaceutical industry regarding the price and patient access
to HIV and viral hepatitis drugs. For more information, please visit www.fairpricingcoalition.org.