I have Medicare and my medication is an infusion that I get in a medical office.
There may be resources that can help lower your costs for infusion disease modifying therapies. Remember that these are generally billed twice, once for the cost of the drug and once for the cost of the administration
Medicaid (also called Medical Assistance):
If you have limited income (under about $1,000 per month if you’re single) and limited assets you should apply for Medicaid
in the state where you live. Medicaid will pay participating doctors, pharmacists, hospitals, or other providers for your care. Find Medicaid’s contact information here
Medicare Savings Program (MSP):
- MS Navigator Tip: If you’re low income but not eligible for Medicaid, ask if your state offers a “spend down” or “medically needy” program that can help you get Medicaid benefits.
Also available through Medicaid, MSP
may help with Medicare A and/or B costs, although eligibility is limited to individuals who have low income (around $1,350/month for an individual or $1,800/month if you’re married) and limited assets. Learn more about eligibility guidelines in your state
, and contact Medicaid if you wish to apply
There are several nonprofits that help with Medicare prescription costs for the MS disease modifying therapies. Their assistance will count toward your out-of-pocket costs to get you through the donut hole more quickly.
Pharmaceutical Assistance Programs:
- MS Navigator Tip: If these programs don’t have funds when you call, you are encouraged to check back as often as possible (daily, if that is an option) to see if their funding status has changed.
- MS Navigator Tip: The Patient Access Network offers a FundFinder notification service for people in need of funding for MS therapies and premium assistance. Once a free account has been created, validated and the Multiple Sclerosis programs selected, users will receive updates when a program receives new funding. Register here.
When all other resources have been exhausted, contact your drug manufacturer's Patient Assistance Program
to request help with making your medication affordable. Tell them that you cannot adhere to your treatment without assistance. Realize, though, that pharmaceutical company funding is not always available for Medicare recipients and any assistance they provide will not count towards your out-of-pocket costs. When you call, explain that you cannot afford the cost of your treatment and that without the assistance program’s help you will not be able to adhere to your treatment.
Help with the cost of infusion administration:
If you need help specifically with the costs of administering your infusion medication, the following resources might also help:
Some people with high healthcare costs may benefit from looking into other ways to get their Medicare. Programs such as as Medicare Advantage Plans
can limit annual spending. Our Benefits & Employment Support Team is happy to discuss your coverage options. Contact an MS Navigator