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Guide to Prescription Financial Assistance

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If you need help paying for your medication, our guide can help you find the right assistance.

This guide was created by MS Navigators on the Benefits & Employment Support Team. We have taken care to include every possible disease modifying drug cost help solution we are aware of – if you need help navigating this page please contact us.

This guide is organized into three sections:

For people WITHOUT health insurance.

Learn more about free drug programs.

For people WITH health insurance.

Drugs can be expensive even with insurance for many reasons. Find the right solution.

For people who need help with medical bills or a drug that isn’t an MS disease modifying therapy.

Learn more about the resources available.

Without Health Insurance

If help is available, it will be through the Pharmaceutical Company’s Free Drug Program. If your drug’s pharmaceutical program doesn’t offer free drugs, you may need to talk to your neurologist about how the cost is preventing you from adhering to your treatment.

Learn about health insurance options.
 

With Health Insurance

Drug is Not Covered by My Insurance

If your medication isn’t covered under your health insurance, work with your healthcare provider to file an appeal (ask the plan to cover the drug based on your unique health needs).
  • MS Navigator Tip: As more ‘generics’ for disease modifying therapies are introduced to the market each year, it’s not always possible to win an appeal for coverage of your preferred product, especially without evidence from your medical history to support your appeal.
Information you can share with your doctor including template appeal letters.

I have Medicare and I get my medication at a pharmacy or through the mail.

There may be resources that can help you lower your costs for disease modifying therapies.
  • MS Navigator Tip: These programs are listed in order of highest value assistance to lower value assistance. Take care to review each one and to apply if you may be eligible.
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.
  • 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.
The Low Income Subsidy, or “Extra Help” program: If you have limited income (around $1,580/month if you’re single or about $2,130/month if you’re married) and assets, this program may assist with Part D (prescription) costs including monthly premiums, annual deductibles and copays. Information is available on the Social Security Administration's website. The application is available online or you can call 1-800-772-1213 to apply over the phone.

State Pharmaceutical Assistance Program (SPAP): Some states fund SPAPs to help residents pay for prescription drugs. Some programs serve specific populations based on age, disability status and/or a specific diagnosis. Find out if SPAP is available in your state.

Nonprofit Funding: 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.
  • 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.
Pharmaceutical Assistance Programs: When all other resources have been exhausted, contact your drug manufacturer's Patient Assistance Program to request help with making your medication affordable. 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 copay for your treatment and that without the assistance program’s help you will not be able to adhere to your treatment.

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.
  • 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.
Medicare Savings Program (MSP): 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.

Nonprofit Funding: 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.
  • 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.
Pharmaceutical Assistance Programs: 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 or Medigap can limit annual spending. Our Benefits & Employment Support Team is happy to discuss your coverage options. Contact an MS Navigator.

I have coverage through an employer OR I have coverage I bought on my own through the Marketplace or insurance company

Most disease modifying medications prescribed for MS have patient assistance programs to help with the cost of the medication for people who are underinsured. See a list of these programs to find the one that helps with your drug. When you call, explain that you cannot adhere to your prescribed medication without assistance.
  • MS Navigator Tip: Some pharmaceutical companies will help with infusion administration costs. These are often separate programs than the programs that assist with the cost of the drug itself. Contact your pharmaceutical program to ask if they offer help with infusion administration.
The Assistance Fund's MS Copay Assistance Program - 877-245-4412: The Assistance Fund’s Multiple Sclerosis Insurance, Travel, and Incidental Medical Expenses will consider assisting with the cost of infusion administration costs when funding is available. Check their funding status here or call 855-263-1772.
  • MS Navigator Tip: If your disease modifying therapy is an infusion, make sure you’re using an infusion center that is in your plan’s network. If you pay a coinsurance (a percentage of the cost of the infusion administration, not a set copay amount), it’s in your interest to compare administration costs. Hospital-based infusion centers can be much more costly than stand-alone infusion centers. Search the Infusion Center Locator or ask your health insurance company and/or neurologist’s office for information about other infusion centers in your network.

I have Medicaid.

Contact Medicaid to discuss why the costs for your medication are higher than you expected. There may have been an error in the pharmacy’s billing.

If the cost is still too high, you might be able to negotiate a reduced price or payment plan, or may be able to get help with other needs to free up your budget to pay the medical bill. Learn more at the Patient Advocate Foundation.

I need help with medical bills or with a drug that isn’t a disease modifying therapy.

It can be difficult to get assistance for past medical bills. You might be able to negotiate a reduced price or payment plan or you may be able to get help with other needs to free up your budget to pay the medical bill. Learn more at the Patient Advocate Foundation.

Cost Help for other Medications – NOT DMTs

For help finding assistance with medications other than the MS disease-modifying therapies, like symptom management medications, please visit NeedyMeds, a trusted national non-profit information resource. Use the NeedyMeds site or call 1-800-503-6897 to find all available programs for a medication (brand-name or generic) or condition. Access to the site is free and requires no registration.
  • MS Navigator Tip: In some cases, drug discount cards can help to lower out-of-pocket costs at the pharmacy. The National MS Society does not recommend any specific cards, in part because each individual has unique needs. Ask your trusted healthcare providers and pharmacists for their advice, and RxAssist has a list of questions to ask to help you find a card that will work for you.

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