Public Insurance

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Step 1: Contact Non-Profit Foundations

For patients with Public Insurance, the next step to obtain copay assistance is to contact a Non-Profit Foundation and apply for a grant program.

To qualify for help from a Non-Profit Foundation:

  • You must live and receive treatment in the United States
  • You must have Public Insurance (Medicare, Medicaid or Government Funded Insurance Plan)
  • You must be prescribed a medication that is FDA approved to treat your diagnosis
  • Your household income must fall at or below the Federal Poverty Level outlined within each program’s guidelines (these vary for each organization)

You will need a couple of things prior to getting started:

  • Your Diagnosis, including the ICD 10 code that goes along with it
  • Your Doctor’s information (They will need to verify your diagnosis)
  • The name of the medication you need assistance with
  • Your income information from the previous year
  • In order to apply online, you will need a valid email address

When you have all this information available you can get started.  Your will go to each individual website or call them on the phone.  Most of the online application take between 7-10 minutes to complete.  This may take longer over the phone based on hold times.  Once you present all your information above you will know if you qualify for assistance.  If the assistance is granted you will be provided with a Virtual Pharmacy Card, this information will go to your Specialty Pharmacy.

If you are required to submit documentation of income or other documentation this must be done within 30 days or you will forfeit your grant.

You may need to apply for more than one grant program in order to cover the cost if you are on more than one Specialty Medication.

See a list of Non-Profit Foundations contact information below:

Step 2: Contact the Manufacturer Patient Assistance Program

Most brand name Specialty Medications have Patient Assistance Programs that can help guide you through this process. If you signed consent when the medication was prescribed for the Patient Assistance Program to reach out to you, they may have already called. If they haven’t this would be the first place you would want to call. For Publicly Insured patients, you are not eligible for a coupon card, they can help direct you to Non-Profit Foundations that offer copay assistance or if you are unable to obtain help there, they can direct you to their own Patient Assistance Programs if they are available. You may be required to provide proof of diagnosis or proof of income to qualify for Patient Assistance Programs or Manufacturer Coupon Cards.

See the list of Manufacturer Patient Assistance Programs below:

ASTHMA

  • Cinqair: Teva Support Solutions 1-844-838-2211
  • Dupixent: Dupixent MyWay 1-844-387-4936
  • Fasenra: Fasenra 360 1-833-360-4357
  • Nucala: Gateway to Nucala 1-844-468-2252
  • Xolair: Genentech Access Solutions 1-866-422-2377

PULMONARY FIBROSIS

  • Esbriet: Genentech Access Solutions 1-866-422-2377
  • Ofev: Open Doors 1-866-673-6366

PULMONARY HYPERTENSION

  • Adcirca: Assist 1-877-864-8437
  • Adempas: AIM 1-855-423-3672
  • Letairis: Gilead 1-866-664-5327
  • Opsumit: Jansen CarePath 1-866-228-3546
  • Orenitram: Assist 1-877-864-8437
  • Remodulin: Assist 1-877-864-8437
  • Revatio: Pfizer 1-866-706-2400
  • Tracleer: Jansen CarePath 1-866-228-3546
  • Tyvaso: Assist 1-877-864-8437
  • Uptravi: Jansen CarePath 1-866-228-3546
  • Veletri: Jansen CarePath 1-866-228-3546
  • Ventavis: Jansen CarePath 1-866-228-3546

ALPHA-1 ANTITRYSIN DEFICENCY

  • Glassia: One Path 1-866-888-0660
  • Prolastin: Proalstin Direct 1-800-305-7881
  • Zemaira: Zemaira CareZ 1-866-936-2472

SARCOIDOSIS

  • HP Acthar Gel: Acthar Hub 1-888-435-2284

CYSTIC FIBROSIS/ NON-TUBURCULOSIS MYCOBACTERIAL LUNG DISEASE

  • Arikayce: Arikares Support Program 1-833-274-5273
  • Bethkis: Chiesi CareDirect 1-888-865-1222
  • Cayston: Cayston Access Program 1-877-722-9786
  • Kalydeco: Vertex GPS 1-877-752-5933
  • Kitabis Pak:Kitabis Connect 1-844-548-2247
  • Orkambi: Vertex GPS 1-877-752-5933
  • Pulmozyme: Genentech Access Solutions 1-866-422-2377
  • Pancreaze: The Pancreaze Assistance Program 1-855-751-5540
  • Symdeko: Vertex GPS 1-877-752-5933
  • Tobi Podhaler: Podcare+ 1-877-999-8624

Step 3: Contact the Specialty Pharmacy

The Specialty Pharmacy will dispense the medication to be mailed to your home.  If you have tried the other steps and still have an unaffordable copay speak with the representative at the Specialty Pharmacy.  They may be able to direct you to other resources; some have in house patient assistance programs.  Ask to speak with their Patient Advocate if they have one.

See a list of Specialty Pharmacy contact information below:

  • Accredo/CuraScript/ExpressScripts: 1-866-344-4874
  • Briova/OptumRx: 1-855-856-0536
  • Cigna Tel-Drug: 1-855-326-7463
  • CVS/Caremark: 1-877-242-2738
  • Diplomat: 877-977-9118
  • Humana Specialty Pharmacy: 1-855-478-8405
  • Kroger Specialty Pharmacy: 855-802-3230
  • Walgreens/Medmark: 1-888-347-3416

Step 4: Reach out for Assistance other than Copay

If you had made attempts at obtaining help paying for your medication and are still under a financial burden, there is help out there.  Some of the Non-Profit Foundation can help with other cost such as travel to doctor’s appointment, help paying insurance premiums and support for your caregiver. Your doctor may be able to refer you to a social worker that can help put you in touch with assistance available in your specific county.  Don’t be afraid to ask for help if you need it.  

 

Non-Profit Foundations

Updated 9/18/2022

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