Psoriasis patients are often broken down into three categories: they either have mild, moderate, or severe psoriasis. But a potentially more useful breakdown concerns a patient’s ability to pay for prescription treatments: people with good insurance, the underinsured, and the uninsured.
For those with good insurance, psoriasis treatment is tricky enough: evaluate the safety and effectiveness of various treatments and select one or more to use. But for the other two groups, the underinsured (those with high copays or major coverage gaps) and the uninsured, it is even trickier. For them, their out-of-pocket treatment cost is considered right alongside, or even before, such things as safety and effectiveness.
In our article Psoriasis Treatment Strategies for the Uninsured, we propose some ways people can try to work around their financial limitations. One way is to make use of programs the pharmaceutical and biotech companies (the drug companies) support that can reduce or even eliminate out-of-pocket costs for some psoriasis and psoriatic arthritis patients in the United States. (In fact, these programs exist for many drugs for many conditions, so much of this information could assist you if you are also being treated for other ailments.)
These programs are sometimes referred to as Patient Assistance Programs. Companies generally run programs for their own products, and then sometimes also contribute to nonprofit foundations that help purchase prescription medications for some patients who are unable to pay for them.
We have links below to websites for many of these programs, but first some things you will need to know.
THESE PROGRAMS CAN SOUND CONFUSING, BUT THEY DO WORK FOR MANY PATIENTS SO DON’T GIVE UP IN FRUSTRATION.
In fact, once you figure them out, some of them are surprisingly simple. We interviewed an uninsured woman (see below) who is loving her life and living nearly psoriasis free… receiving more than $10,000 annually in free medications…at no cost to her!
The companies typically offer two different programs. One is a co-pay assistance program for the commercially insured, that can often dramatically reduce (or even eliminate) out-of-pocket costs for patients. A separate program can provide drugs free-of-charge to some uninsured patients who meet certain income limits that vary by company. The programs typically last one year and can be renewed.
Some doctors enthusiastically assist their patients through the paperwork, while others leave it to the patient.
The co-pay assistance programs often help all patients regardless of income level. For example, using Abbott’s program, Humira patients with private insurance can have their co-pay cut to just $5! Other companies have comparable programs. (See below.)
For those without insurance, the company-backed foundations can provide equally dramatic benefits.
Caroline, from North Carolina, is a 23 year-old student who was diagnosed with psoriasis three years ago. She works part-time but has no health insurance. Steroids kept her psoriasis at bay for a while, but as her psoriasis spread, she and her doctor discussed other options.
Fortunately, her physician educated her about these programs for the uninsured, and the dermatology clinic even did the leg work in applying for her. She decided to apply to Amgen & Pfizer’s ENcourage Foundation seeking Enbrel for her psoriasis. There was a short form to fill out and she submitted her previous year’s tax return.
“It was quite easy to apply,” Caroline says. “I have been very fortunate to have a doctor who works with me and does his best to get me the best medical care though I am uninsured.”
She was quickly approved by the ENcourage Foundation. She is now receiving one-year’s worth of Enbrel at no charge and will reapply for another year when it is time to do so. (Other patients report similar stories about other companies’ assistance programs and foundations.)
Caroline reports: “Enbrel is really working for me. I am seeing results I could have never imagined. While I have not been completely clear, I have come pretty close. Before starting my scalp was covered. I had large spots on my legs, feet, arms, hands, and trunk. The pain and itching was unbearable. I was literally thinking I would be unable to work or live a normal life if my condition continued on the way it was. Now I have very few spots, most which are barely noticeable. … My life is not consumed by my condition anymore. I barely think of it. I have to remind myself that I suffer from this disease. The results have been amazing.” [Photo of Caroline by Kabryn Mattison]
Caroline supplements her Enbrel with topical treatments for tough-to-clear areas. Her dermatologist gives her free samples of Clobex and Luqix, which are topical steroids. (Company sales reps give free samples to doctors. While some critics say this unduly influences doctors’ prescribing habits, it does give some patients another way to access prescriptions at no charge.)
She also participates in another company program. Her doctor gave her a voucher for the drug company Galderma’s program that provides her free Vectical, a synthetic vitamin D3 ointment, in exchange for her taking part in a few brief phone surveys.
Caroline, with the help of a supportive dermatology practice, has made the most of these company programs. She urges others who lack adequate insurance to do what she has done.
“For anyone applying or thinking of applying, my advice would be to go for it and find a doctor who will help you along the way. It’s worth a shot…no pun intended!”
Caroline has also offered to be contacted by patients with questions about her experience. “I can’t tell you how many times I’ve heard a testimony and blew it off, because they weren’t ‘real’ to me. It is important when hearing testimony to know that it’s not a fabrication.” You can contact her here through Psoriasis.Name, the social network for psoriasis patients.
At this point some of you must be asking, “What’s the catch?” Especially since one of the mantras of Psoriasis Cure Now when discussing “miracle cures” is “If it sounds too good to be true, it always is.” Why would companies offer these generous programs? Here are some theories.
First, with respect to programs that reduce or eliminate co-pays for patients with private insurance, remember that the vast majority of a drug company’s revenue comes from what insurers pay, not what patients co-pay. But high co-pays are one big reason patients avoid expensive treatments. By cutting the cost to the patient, and removing that cost barrier, the companies can get more patients using their treatment – that means more money from the insurance companies covering that treatment.
But what about those programs that provide free treatments to the uninsured? In those cases, the companies are donating money to foundations and then those foundations are providing drugs free of charge to needy patients.
We see at least three possible reasons. First, there is great public and political pressure on drug companies to reduce the very high prices they charge Americans for prescription medications – even when those same treatments are sold in other countries for less. By providing free drugs to some of the uninsured who are in need, and reducing the out-of-pocket cost to insured patients, the companies are easing some of the problems caused by high drug prices. Put differently, if Congress ever acted to force reductions in drug prices, the results would be far worse for these companies than in voluntarily providing these limited programs.
Second, these companies are run by … people, the vast majority of whom are good people who care about others. They take pride in working in a field where their company’s products improve people’s quality of life and even extend lives. These programs do not bankrupt the companies yet allow them to help people access their treatments.
Finally, there might be tax benefits to donating money to a nonprofit foundation that then buys the company’s product.
So business reasons, political considerations, and compassion probably all play a role in driving companies to create these programs.
Other fine print….
Note that we have only talked about financial issues in this article. Just because you can obtain a product for free does not mean you should use it.
You must still decide whether its likely benefits outweigh its risks for you. Many of the treatments available under these programs have serious side-effects in some patients. A few people have died from these products. (More than a million others have been helped.) Which treatment is right for you is still best decided by you and your physician. It is just nice to know that these programs can make the cost issues less central to your decision-making.
(Note also that you agree to provide companies information about you when you apply for these programs. Be sure to read the fine print before applying. For example, consider this statement that programs commonly make you accept to participate in their program: “Once my information is disclosed via this authorization, federal privacy laws may no longer protect it from further disclosure.”)
Below are links to these programs for popular psoriasis treatments. (The links were working and programs were accepting patients as of November 2010.) We recommend you click through a few of these and learn more about what types of benefits they provide and how you apply. For some of you currently on these treatments, you can apply directly. In other cases, you will need your physician’s help.
If you do apply for any of these programs, we would like to hear how it works out for you. Please drop us an email and let us know how it goes. Good luck! And if you want to find this page in the future, you can get here directly by visiting www.psoriasis-HELP-now.org .
Psoriasis treatments with co-pay assistance and/or programs to help the uninsured:
Enbrel (etanercept)
For the uninsured: http://wwwext.amgen.com/citizenship/encourage_enrollment_forms.html
For co-pay assistance, etc.: http://www.enbrel.com/pay-for-ENBREL.jspx
Humira (adalimumab)
Start here for all programs: http://www.humira.com/Global/FinancialHelp/Default.aspx
Remicade (infliximab)
Insurance/reimbursement information: http://www.remicade.com/remicade/global/getting_support/insurance_information.html
For the uninsured: http://www.jjpaf.org/eligibility/index.html
Amevive (alefacept)
Co-pay assistance: http://amevive.com/StartingLoyalty.aspx
No insurance or underinsured: http://astellasreimbursement.com/products/Amevive/Astellas_Access_Program/patientguide.php
Simponi (golimumab)
For the uninsured: http://www.jjpaf.org/eligibility/index.html
Co-pay assistance: http://simponi.com/simponi/assets/pdf/simponione-patient-cost-support.pdf
Stelara (ustekinumab)
For the uninsured: http://www.jjpaf.org/eligibility/index.html
Co-pay assistance: http://www.stelarainfo.com/patient-support/cost-support
Soriatane (acitretin)
Visit these for all support programs:
http://www.gskforyou.com/
http://www.caresbygsk.com/patients-caregivers.html
Vectical (calcitriol)
Co-pay assistance: http://www.psoriasissavings.com/
Taclonex (calcipotriene and betamethasone dipropionate)
Co-pay card: http://www.altsampling.com/taclonexactivate/
Clobex (clobetasol propionate)
Co-pay assistance: http://www.psoriasissavings.com/
Luxiq (betamethasone valerate)
Visit these for all support programs:
http://www.gskforyou.com/
http://www.caresbygsk.com/patients-caregivers.html
