Insurance and Reimbursement Resources for MDS Patients
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1 Insurance and Reimbursement Resources for MDS Patients A Guide to Assistance Programs in the United States Third Edition the myelodysplastic syndromes foundation, inc. Published by The Myelodysplastic Syndromes Foundation, Inc., 2009
2 We have assembled a listing of assistance programs available to MDS patients. It is important to know that there is support for those who cannot afford medicine or other healthcare costs. We hope this new resource will be beneficial in helping you with your medical needs. Facts you should know about Medicare Part B coverage categories: 1. Oral Anticancer Drugs. Oral drugs used for cancer treatment provided they have the same active ingredients and are used for the same indications as chemotherapy drugs that would be covered if they were not self-administered and were administered as incident to a physician s service. 2. Oral Antiemetic Drugs. Oral anti-nausea drugs used as part of an anti-cancer chemotherapeutic regimen as a full therapeutic replacement for IV anti-emetic drugs within 48 hours of chemotherapy. 3. Erythropoietin (EPO). Treatment of anemia for persons with chronic renal failure who are undergoing dialysis when given in the dialysis center or when given incident to a physician s service for other approved uses. 4. Durable Medical Equipment (DME) Supply Drugs. Drugs that require administration with an infusion pump in the home if medically necessary (e.g., some chemotherapeutic agents). 5. Drugs furnished incident to a physician s service. Drugs used in immunosuppressive therapy (such as cyclosporine) for a beneficiary who has received a Medicare covered organ transplant. Facts you should know about Medicare Part D: 1. You have to enroll to get Part D. If you have Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance), you are not automatically enrolled in Part D. You have to enroll in a specific Part D plan. 2. There will be additional costs. In a basic benefits plan, a coverage gap can exist. Out-of-pocket costs would be: $295 deductible You then pay 25% of the next $2,405 (25% of $2,405 = $601.25) Donut hole threshold = $2,700 What you and the plan have spent ($295 + $2,405 = $2,700) You then pay 100% of the next $3, of drug costs (the donut hole ) Then, catastrophic coverage begins after you have spent $4,350. This is your total out-of-pocket spending requirement ($295 + $ $3, = $4,350) 3. Observe enrollment periods. During open enrollment, you can review plan choices to see which best fits your prescription drug needs. You can choose a new plan or remain with your current one. Open enrollment is between November 15 and December 31 each year. 2
3 4. Compare plan formularies. Research drug plans to take advantage of lower copays. You may pay a little more each month, but you will probably save money in the long run! Medicare offers a tool to help you find health plans in your state that match your required drug list at: About 40 states have assistance programs to help low-income patients, who can also get help with Medicare Part D costs, either through their state or Medicare. Check with your Area Agency on Aging (to find yours, call ). Additional Resources: Government Assistance Formulary Finder for Prescription Drug Plans This tool will allow you to find health plans in your state that match your required drug list. Medicare and Medicaid Prescription Drug Programs: Provides information about prescription drug coverage. Centers for Medicare and Medicaid Services Department of Health and Human Services 200 Independence Avenue, S.W., Washington, DC Social Security Disability Programs: The Social Security and Supplemental Security Income disability programs are the largest of several federal programs that provide assistance to people with disabilities. Medication & Underinsured Assistance Chronic Disease Fund: This program provides assistance to those underinsured patients who are diagnosed with chronic or life-altering diseases. 3
4 HealthWell Foundation: This charitable organization offers copay assistance for MDS medications. Hours are Monday to Friday from 9:00 AM to 5:00 PM EST. National Organization for Rare Diseases: or Medication Assistance Program Needy Meds: A resource for people who cannot afford medicine or other healthcare costs. Needymeds has information on over 600 programs. Partnership for Prescription Assistance: PPA-NOW ( ) Prescription assistance programs, often sponsored by drugmakers, help patients who qualify based on financial need. Search this website for a comprehensive listing of more than 475 public and private patient assistance programs, including nearly 200 programs offered by pharmaceutical companies. Patient Access Network Foundation: PANF ( ) This foundation assists patients with their coinsurance associated with MDS treatments/ medications. Hours are Monday to Friday from 9:00 AM to 5:00 PM EST. Patient Advocate Foundation: This program provides direct copayment assistance for pharmaceutical products to insured Americans who financially and medically qualify. Patient Services, Inc.: A nonprofit charitable organization primarily dedicated to subsidizing the high cost of health insurance premiums and pharmacy copayments for persons with specific chronic illnesses and rare disorders. RxAssist: This program provides a comprehensive database of patient assistance programs. 4
5 Together Rx Access: This program is free and offers savings of 25% 40% on over 300 brand name and generic prescription drugs. Specialty Pharmacies That Carry MDS Medications Accredo Nova Factor: ( Offers specialized care and support for patients. Their clinical, educational and reimbursement services are tailored to meet each patient s individual needs. They will even help untangle your insurance coverage. BioScrip: ( Your complete source for effective specialty pharmacy solutions, from personalized patient support services to medication management programs for health plans. Diplomat Specialty Pharmacy: ( Provides clinical and reimbursement solutions to patients with oncologic and hematologic disorders. Diplomat s Oncology Navigator Program provides a dedicated team to help patients and healthcare professionals gain access to required oncology medications. US Bioservices: ( Delivers nationwide specialty pharmacy and nursing services that meet the unique needs of patients. Pharmaceutical Company Assistance Alexion Pharmaceuticals, Inc. The Soliris OneSource Program: Soliris ( ) Soliris OneSource is a treatment support service for all paroxysmal nocturnal hemoglobinuria (PNH) patients and their healthcare providers. Soliris (eculizumab) is the first and only therapy approved for PNH, a rare, disabling and life-threatening blood disorder characterized by chronic red blood cell destruction, or hemolysis. Amgen Reimbursement Connection: Amgen s patient assistance programs provide replacement product for uninsured or underinsured qualifying patients with limited financial resources. Program includes Aranesp, Neulasta, Epogen, Vectibix, and NPlate. 5
6 Bayer HealthCare Pharmaceuticals Leukine Reimbursement Program: Provides answers to reimbursement and coverage policy questions. Hours of operation are Monday to Friday from 9:00 AM to 5:00 PM EST. Celgene Corporation Celgene Patient Support : A dedicated central point of contact helping providers and patients identify resources to gain access to Celgene products, including Revlimid and Vidaza. Available to answer your questions Monday to Friday from 8:00 AM to 7:00 PM EST The RevAssist Program: A proprietary risk-management education and restrictive distribution program for patients who have been prescribed Revlimid. Information about Revlimid can be obtained by calling the Celgene Customer Care Center toll free Monday to Friday from 8:00 AM to 8:00 PM EST and Saturday from 9:00 AM to 3:00 PM EST. RevAssist registration may be completed by visiting RevAssist Online or by calling the Celgene Customer Care Center. Eisai, Inc. Dacogen Patient Assistance and Reimbursement Program: Provides information on Dacogen reimbursement services. Available Monday to Friday from 9:00 AM to 8:00 PM EST. Novartis Oncology: EPASS ( ) EPASS (EXJADE Patient Assistance and Support Services) EXJADE prescription and reimbursement program helps ensure that patients receive their prescriptions on time at home or the location of their choice. EXJADE ScriptAssist Program Assistance and support services hotline for patients already receiving EXJADE. Contact your specialty pharmacy to determine your eligibility and to enroll in this cost savings program. Eligible patients can receive up to $100 toward out-of-pocket expenses for up to 9 EXJADE prescriptions for a total savings of up to $900. Contact EPASS Complete Care Monday to Friday from 9:00 AM to 8:30 PM EST
7 Centocor Ortho Biotech, Inc. ProcritLine: Resources to help patients or caregivers learn more about treatments or financial programs. Hours of operation are Monday to Friday from 9:00 AM to 8:00 PM EST. Write Your Legislators Letters do make a difference There is power in numbers. To locate your legislator: For a Representative of the House The Honorable (First and Last Name) United States House of Representatives Washington, DC Dear Representative (Last Name): or For a Member of the Senate The Honorable (First and Last Name) United States Senate Washington, DC Dear Senator (Last Name): Tips for Writing Congress State your purpose for writing in the first sentence of the letter. For example, As your constituent, I am writing to urge your support for increased funding for health care. Include personal information about why the issue matters to you to make your point. If your letter pertains to a specific piece of legislation, identify it. And make sure that you are referencing the correct legislation to the correct body of Congress. House bills are H.R. ; Senate bills are designated as S.. It is also important to know the status of the bill. Be courteous. Close your letter with a restatement of your purpose and indicate the response that you expect. Please call The MDS Foundation at MDS-0839 for additional information. 7
8 The MDS Foundation, Inc. 36 Front Street, P.O. Box 353 Crosswicks, NJ If you would like additional information, please contact us by phone or fax: Phone: 800-MDS-0839 Fax:
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