SLIDE 1 THE LINK BETWEEN YOU AND MEDICARE This material has been created or produced by CLAIM with financial assistance, in whole or part, through a grant from the Administration for Community
- Living. Funding is administered through the Missouri Department of Commerce and Insurance and service is provided by Primaris Foundation, a
non-profit organization.
Prescription Assistance Programs
SLIDE 2
Learning Objectives
Be familiar with the resources available to find assistance programs Review common Prescription Assistance Programs (PAPs) and their recent changes Be able to use fundfinder to find assistance from Foundation Assistance Programs Review other techniques to minimize drug costs Understand the potential financial benefit of using assistance programs
SLIDE 3
Prescription Assistance Programs
“Finding non-governmental assistance programs for a Medicare beneficiary’s higher cost drugs can result in MEGA SAVINGS for the beneficiary, which may be much more beneficial than finding the lowest cost Medicare drug plan.” Anonymous
SLIDE 4 First Step
Always screen the beneficiary for Extra Help or Low Income Subsidy (LIS) with SSA
Benefits are lower premiums, deductibles and copays
Beneficiaries eligible for Extra Help may not be eligible for other assistance programs
SLIDE 5
Benefits of Extra Help (LIS)
SLIDE 6
Types of Assistance Programs
Patient (Manufacturer) Assistance Programs (PAPs) Foundation (Charity) Assistance Programs
SLIDE 7 Recommended Tools
CLAIM website
List of PAP programs for common drugs, eligibility requirements and contact information Included in volunteer resources under tip sheets
Needymeds.org Rxassist.org Fundfinder.panfoundation.org
SLIDE 8
Patient Assistance Programs (PAPs)
Many higher cost brand name drugs have PAPs from the manufacturer If eligible, medications are normally provided at no cost Some PAPs exclude Medicare beneficiaries Some PAPs consider Medicare beneficiaries on a case by case basis
SLIDE 9 Eligibility Requirements for PAPs
Income limits – 200%-600% of FPL 200% single $2127/mo couple $2873/mo 600% single $6380/mo couple $8620/mo No asset/resource limit For some PAPs, beneficiary can’t be eligible for LIS For some PAPs, CY OOP costs on meds have to exceed 2%-4% of annual household income For some PAPs, CY OOP costs on meds must exceed a fixed dollar amount
SLIDE 10
Program Lists on CLAIM Website
Insulin and diabetes medications Inhalers Other common medications
SLIDE 11
Insulin/Diabetes Assistance
SLIDE 12
Inhaler Assistance
SLIDE 13
Other Rx Assistance
SLIDE 14 Case Study
Drug : Imbruvica Disease: Chronic lymphocytic leukemia Full price of drug: $12K-$13K per MONTH Extra Help: Not eligible Planfinder pdp costs
Initial month $2500 (thru coverage gap) Catastrophic coverage $600-$700 per month
SLIDE 15 Case Study
Manufacturer assistance program
Johnson & Johnson Eligibility: Income less than 600% of FPL
Single $6380/mo, Couple $8620/mo
Result: MEGA SAVINGS
SLIDE 16
Types of Assistance Programs
Patient (Manufacturer) Assistance Programs (PAPs) Foundation (Charity) Assistance Programs
SLIDE 17 Foundation Assistance Programs
Individual funds for specific diseases Dependent on funding Each fund may close, reopen or limit it to renewals at any time Most income limits are 400%-500% of FPL
400% single $4253/mo couple $5747/mo 500% single $5316/mo couple $7184/mo
SLIDE 18
Foundation Assistance Programs
No asset/resource limits Most operate with fixed amount of a grant that pays copays of a Medicare plan Some funds also give assistance for premiums or medical costs
SLIDE 19
Common Foundation Programs
Patient Assistance Network (panfoundation.org) Healthwell (healthwellfoundation.org) My Good Days (mygooddays.org) The Assistance Fund (tafcares.org) Leukemia & Lymphoma Society (lls.org) Cancer Cares (cancercare.org) Patient Advocate (copays.org) Patient Services Inc (patientservicesinc.org)
SLIDE 20
Fundfinder
One website to find or follow disease funds Includes nine foundation assistance programs Includes over 200 diseases/conditions Identifies open and closed disease funds with links to foundations Will send an email when a closed fund opens again Fundfinder.panfoundation.org (Bookmark it!)
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Other Counseling Tips for Rx Costs
Generics/Samples/Alternative Rx Formulary and tier exceptions Preferred network pharmacies 90 day supply/mail order Good Rx/Singlecare Other discount programs Missouri Rx
SLIDE 22
STARS Entry
SLIDE 23
Prescription Assistance Programs Share Your Experiences!! dthran@missouriclaim.org 417-812-6021
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Thank You! Questions?
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