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Thursday, February 6, 2014

Copayment Assistance

I had the opportunity to visit Pharmacyclics headquarters today.  It was the first time I've been there since 2007 when I was helping them design their original first in human phase I protocol (read part of that story here).

Thanks to all the nice people who took time out of their day to chat!  It was fun to see the excitement brewing within a company that has developed a really remarkable drug.  It felt to me a lot like the fun anticipation of Christmas Eve with kids (except with well behaved adults of course).

One thing I learned will be of considerable interest to a bunch of patients, so I thought I would throw a quick blog post up while awaiting my flight (back to a snowy Eugene... Lord help me).

Many of you know that the new drugs are pretty darn expensive.  I've posted about drug costs previously for the interested reader.  I think a lot of patients are reasonably apprehensive of the cost of care.  For a drug that costs over $10K/month, that can potentially put the hurt on you really fast.

Fortunately the team at Pharmacyclics / Jannsen have put together a pretty fantastic copayment assistance program.  Many drug manufacturers have such a program and sometimes these can remain stubbornly hidden to patients who have to fork out the cash every month for their drugs unaware that funding assistance may be available with a little work.

There are really two different mechanisms depending on what sort of insurance you have.  For NON-MEDICARE patients (ie. the Blue Cross, Aetna, etc), you can apply for a grant if you are taking your ibrutinib for an FDA approved indication (see post on off label drug use).  Currently that is just mantle cell lymphoma, though the approval in CLL is eagerly anticipated by many.  Once approved in CLL, the grant program will cover that disease as well.

Long story short, a NON-MEDICARE patient should be able to get their drug for $25/month under most circumstances when using the copayment assistance program.  The link to that program is here.

Medicare patients have a slightly more difficult situation, but by no means impossible.  Since CLL frequently affects older patients, quite a few patients are likely to fall into this category.  Medicare has policies that make it more difficult for manufacturers to provide copayment assistance.  The work around is for the companies to make large grants to third party organizations like Lymphoma and Leukemia Society that can then make structured grants to patients.  The copayment assistance webpage can help direct patients to such organizations.

US Healthcare is an ungodly mess when it comes to who pays for what, what things cost, and who gets paid for it - but it is nice to know the patients are not getting caught in the crossfire on this one.

Thanks for reading