How to Get Financial Help for Biologic RA Treatments

By

Beth W. Orenstein

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Combination Therapy for RA

Treating RA early and aggressively could mean taking more than one RA drug at the same time, a process known as combination therapy.
Know What Your Insurance Covers

Since biologics were introduced in 1998, they have helped many people with rheumatoid arthritis function better. Two out of three people treated with biologics, which must be injected or given intravenously (through an IV), do well on them.

However, biologics are quite costly. They can range from $12,000 to $30,000 a year. Biologics are pricey because they are costly to produce. Biologics are genetically engineered medications made from living organisms. The raw materials needed are expensive and the manufacturing process is more complicated than other types of drugs.

Many health insurance plans will cover at least some of the cost. You need to check with your insurance company to find out whether it has any special requirements. For example, your insurance company may reimburse you differently for drugs given by injection or IV.

Some insurance plans will require you to get prior authorization before you receive injectable or specialty medications and are reimbursed for them. Also, if you are thinking of switching insurance plans, check to see whether coverage of your biologics will change.

Reducing Costs: Help From Manufacturers

Manufacturers that make these powerful drugs have a variety of programs that help people pay for their RA biologics. If you don’t have insurance or have a limited income, you are likely to qualify for their assistance.

You can find more information about eligibility and how to apply for assistance at these manufacturers’ websites:

Abatacept (Orencia)

Bristol-Myers Squibb Patient Assistance Foundation

www.bmspaf.org

Adalimumab (Humira)

Abbott Patient Assistance Foundation

www.humira.com/global/financial-assistance.aspx

Anakinra (Kineret)

Kineret Patient Assistance Program

www.kineretrx.com/professional/reimbursement/reimbursement.jsp

Certolizumab Pegol (Cimzia)

Cimzia Co-Pay Savings Card

www.cimzia.com/savings/

Etanercept (Enbrel)

Amgen/Pfizer ENcourage Foundation

www.encouragefoundation.com/index.jsp

Infliximab (Remicade)

Johnson & Johnson Patient Assistance Program

www.jjpaf.org

Golimumab (Simponi)

SimponiOne Support

www.simponi.com/simponione-support/support

Tocilizumab (Actemra)

Actemra Co-Pay Card Program

www.actemra.com/actemra/rheumatoid-arthritis/financial-assistance.html

Reducing Costs: Help From Nonprofits

A number of nonprofit programs are available to help people who can’t afford their medications:

NeedyMeds

P.O. Box 219

Gloucester, MA 01931

www.needymeds.org

NeedyMeds is an information resource that helps people who cannot afford medication or healthcare costs find programs that can assist them. You don’t have to identify yourself and may be able to get help free of charge.

The Patient Advocate Foundation

421 Butler Farm Road

Hampton, VA 23666

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Apr 9, 2015

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Medical References

  1. 2011 Injectable Medications and Specialty Pharmaceutical Drugs. BlueChoice Health Plan, South Carolina. http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/specialtypharmaceuticallist.pdf
  2. Bristol-Myers Squibb Patient Assistance Foundation. http://www.bmspaf.org
  3. Cimzia Co-Pay Savings Card. http://www.cimzia.com/savings/
  4. Abbott Patient Assistance Foundation. http://www.humira.com/global/financial-assistance.aspx
  5. Johnson & Johnson Patient Assistance Program. http://www.jjpaf.org/
  6. NeedyMeds. http://www.needymeds.org
  7. The Patient Advocate Foundation. http://www.patientadvocate.org
  8. PatientAssistance.com Inc. http://www.patientassistance.com
  9. Biologic Treatments for Rheumatoid Arthritis. American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/medications/biologics.asp
  10. RxAssist. http://www.rxassist.org
  11. Amgen/Pfizer ENcourage Foundation. http://wwwext.amgen.com/citizenship/encourage_foundation.html
  12. Kineret Patient Assistance Program. http://www.kineretrx.com/professional/reimbursement/reimbursement.jsp

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