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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 IndustryPatient 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
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.
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!
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
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
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
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
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,
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
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.