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Pharmaceutical Industry Patient Support Programs

Pharmaceutical Industry Patient Support Programs. Ken McCormick National Director Strategic Accounts and Reimbursement Tibotec Therapeutics July 21, 2009. Common Programs. Reimbursement Hotline Patient Assistance Program Patient Savings Program – Co Pays Together Rx Access2Wellness.

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Pharmaceutical Industry Patient Support Programs

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  1. Pharmaceutical IndustryPatient Support Programs Ken McCormick National Director Strategic Accounts and Reimbursement Tibotec Therapeutics July 21, 2009

  2. Common Programs • Reimbursement Hotline • Patient Assistance Program • Patient Savings Program – Co Pays • Together Rx • Access2Wellness

  3. Reimbursement Hotline • Tibotec Therapeutics Line – convenient toll free hotline for patients and health care providers. • The Tibotec Therapeutics Line provides reimbursement information Benefit verification, prior authorization requirements, appeal process and procedures, alternate sources of payment • Access in to our Patient Assistance Program.

  4. Patient Assistance Program • Free drug to financially eligible patients • One simple application • Multiple products including non HIV meds • Product Shipped to Physician or Pharmacy Card to Patient • There are a number of exception policies relative to the income eligibility • IF IN DOUBT – APPLY!

  5. Access2Wellness • Single Portal to Multiple PAP Programs • Especially meds for co morbidities not covered under ADAP • Download application forms from product links • Access Co Pay Programs

  6. Together Rx • Multi Company Sponsored • GSK, Tibotec Therapeutics, BMS for HIV Products • Assists patients with no insurance up to 400% of FPL who don’t qualify for ADAP or PAP • Provides up to 30% savings • Togetherrxaccess.com

  7. TT Patient Savings Program Eligibility Patients in Commercial Managed Care Income less than 500% of FPL What’s covered 80% of out of pocket costs Maximum coverage of $100 per TT product per month Exclusions All Government Payor Programs ADAP, Medicaid, VA, Medicare Part D Patients who live in Massachusetts

  8. What more can be done? • Streamline application process • Consolidate multiple applications • Potential for 1 universal co pay card or 1 PAP card for participating companies • Similar to Together RX Card

  9. BACK UP SLIDES

  10. Competitive Product Programs No income verification , 2 year eligibility, starts at dollar one, maximum benefit $100 per GSK ARV Provides coverage only for copays over $50. Patient pays first $50 out ofpocket.Coverage $50 - $200 per Gilead ARV. No known income verification No new special co-pay program; eligible patients to use PAP if co-pay exceeds $50 Income verification reported to be loosely enforced Eligibility <500% FPL, Coverage begins at dollar one, 80/20 coverage maximum benefit $100 per TT ARV,

  11. Competitive Product Programs New and existing ATRIPLA patients with commercial insurance who meet certain requirements are eligible for the program, which covers up to $200/month for a full year for patients with an ATRIPLA co-pay greater than $50/month. People will be responsible for paying the first $50 of their co-pay. The Atripla co-pay kicks in for co-pays higher than $50 and provides up to $200 of assistance per month for one year. Thus, if someone’s current co-pay is $250 they will only be responsible for $50 going forward. Eligible patients can enroll by obtaining an ATRIPLA co-pay assistance card from their physician or healthcare provider.  If a healthcare provider does not have an available ATRIPLA co-pay assistance card, patients can call the toll-free number 1-866-784-3431 to receive a card in the mail.  Patients must activate the card prior to first use by calling the toll-free number and answering a few questions to verify their eligibility.  The card must be used for the first time by December 31, 2009 and the final co-pay assistance amount must be paid within 12 months of card activation.  Atripla Program

  12. Competitive Product Programs Covers copays of up to $50 a month for Kaletra. Also covers up to $50 a month for additional ARVs that are part of Kaletra containing regimen with $100 per month limit. No eligibility criteria. Program has expiration date of March 31, 2010. The REYATAZ and SUSTIVA Co-pay Benefit Program will allow eligible patients to save up to $200 of co-pay costs monthly,for up to a year. Patients will be responsible for the first $50 of out-of-pocket costs plus any amount over $250. To begin the enrollment process, eligible patients should speak to their healthcare professional to obtain a co-pay benefit card to take to the pharmacy with their prescription.

  13. Cost Sharing of Out of Pocket Expenses

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