adap advocacy association 2013 hiv/hcv co-infection summit lynda dee fair pricing coalition paps...
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ADAP ADVOCACY ASSOCIATION
2013 HIV/HCV CO-INFECTION SUMMIT
Lynda Dee
Fair Pricing CoalitionPAPS & CO-PAY PROGRAMS
FAIR PRICING COALITION
Martin Delaney
Linda Grinberg
1999
FAIR PRICING COALITION
FPC History Programs and Initiatives Common Form, HarborPath, Welvista HIV & HCV PAP Criteria HIV & HCV Co-Pay Criteria FPC Members & Contact Information
FAIR PRICING COALITION
Worked with ADAP Directors
First ever price freeze (2 years in 2002)
Resulted in $50MIL to ADAPs
Works with ADAP Crisis Task Force
Involved in HCV since 2010
FPC PROGRAMS & INITIATIVES
Initial pricing after FDA approval
Medical CPI for price increases
Patient Assistance Programs (PAPs)
Co-Pay Programs for private insurance
Co-Pay Programs for Part D clients
PAP coverage for the underinsured
HRSA COMMON FORM
Patient name & contact information
Healthcare coverage
Physician’s name & contact information
Alternate shipping information
Prescription information
Signature of patient and provider
http://www.nastad.org/Docs/110312_CPAPA.pdf
WELVISTA& HARBORPATH
One stop shopping
Transitioning from Welvista: Waiting list
Licensed in only 21 states
To HarborPath: All clients
Licensed in all 50 states – one portal
HarborPath.org - 855-300-8916
ABBVIE (ABBOTT) PATIENT ASSISTANCE PROGRAM (PAP)
500% of Federal Poverty Level (FPL)
$4,788 per month/$57,450 per year
Underinsured: Deductibles, Part D copays
Participates with Welvista & HP
BOEHRINGER INGELHEIM (BI)PATIENT ASSISTANCE
PROGRAM (PAP)
500% of FPL
$4,788 per month/ $57,450 per year
Underinsured: Deductibles, Part D copays
Participates with Welvista, not HP
BRISTOL-MYERS SQUIBB (BMS) PATIENT ASSISTANCE
PROGRAM (PAP)
500% of FPL
$4,788 per month/$57,450 per year
Underinsured: Deductibles, Part D co-pays
Participates with Welvista
In negotiaions with HarborPath
GENENTECH/ROCHE PATIENT ASSISTANCE PROGRAM (PAP)
950% of FPL
$9,090 per month/$109,155 per year
Contributes to Co-Pay Foundations
Does not participate with Welvista/HP
GILEAD PATIENT ASSISTANCE PROGRAM (PAP)
500% of FPL
$4,788 per month/$57,450 per year
Underinsured: Deductibles, Part D copays
Participates with Welvista and HP
JANSSEN PATIENT ASSISTANCE PROGRAM (PAP)
200% FPL
$1,915 per month/$22,980 per year
Makes FPL income exceptions
Underinsured: Part D co-pays only
Participates with Welvista and HP
MERCK HIV & HCV PATIENT ASSISTANCE PROGRAM (PAP)
500% of FPL
$4,788 per month/$57,450 per year
Underinsured: Deductibles, Part D co-pays
Participates with Welvista & HP
VERTEX HCV PATIENT ASSISTANCE PROGRAM (PAP)
Monthly household income $8,333
Annual household income $100,000
Underinsured: Case by case
Currently discussing Part D & HP
ViiV PATIENT ASSISTANCE PROGRAM (PAP)
ViiV (Formerly GSK & Pfizer):
500% of FPL
$4,788 per month/$57,450 per year
Underinsured: Part D co-pays only
Participates with Welvista & HP
ABBVIE CO-PAY PROGRAM
Covers first $50 of Norvir
Covers first $200 of Kaletra
Online & healthcare providers
BI CO-PAY PROGRAM
Coverage after the first $25 paid
Covers Viramune XR, not IR
Does not cover Aptivus
Providers, ASOs and pharmacies
BMS CO-PAY PROGRAM
Covers first $200 Reyataz/Sustiva
Covers first $400 for Atripla/Gilead
Online or healthcare providers
GENENTECH HIV AND HCV CO-PAY PROGRAM
No official co-pay program
Donations to Non-Profit Foundations
Depending on Availability of Funds
Private Insurance Patients
Medicare Part D Patients
GILEAD CO-PAY PROGRAM
Covers first $400 for Atripla,
Complera and Emtriva
Covers first $200 for Emtriva,
Truvada and Viread
Providers, ASOs, pharmacies
JANSSEN CO-PAY PROGRAM
Coverage after first $5 paid
Prezista, Intelence, Edurant
Coverage unlimited thereafter
Online or healthcare provider
MERCK HIV & HCV CO-PAY PROGRAM
Covers first $400 for Isentress
Covers first $200 for PegIntron
20% of 12 Rxs/44 weeks of Victrelis
Online or healthcare provider
VERTEX CO-PAY PROGRAM
HCV only
$10,000 for Incivek
No income limit
Vertex or pharmacies
ViiV CO-PAY PROGRAM
ViiV (Formerly GSK & Pfizer):
Covers first $200
Online or healthcare provider
Must re-enroll for 2013
FAIR PRICING COALITIONfairpricingcoalition.org
Bill Arnold Bill ArnoldPaul Arons Bruce BurkettJeff Berry Ryan ClaryLanny Cross Lanny CrossLynda Dee Lynda DeeDavid Evans David EvansMurray Penner Michael Ninburg
Murray PennerLorren Sandt