Hep C Discussion Forum

Michaele · Guru

is anyone on new non interferon Tx using Medicare Part D

Michaele · Guru

Thanks Tig, Im just going to kick back and make cornbeef. Just have to wait until Monday to find out what Dr wants. Michaele

Tig · Admin

Don't let it overwhelm you. Best to find out what your doctor wants to do and then go forward from there with suggestions. Good luck!

Tig

Michaele · Guru

Hi Tig , Im not so sure my dr is going to enjoy the flood of paper work, can a person collect from more than 1 if 1 alone does not cover it all? The woman at AARP said because I have extra asst with my medicare my copay for tier 5 is only $3.60 for brand name I dont think she knew what she was talking about, if I didnt have that asst I Id have to pay out $310 , before thay would address copay and she said it was a % of the cost of drug. Thats scarry. So now you may see my confusion. I may call back and speak to some one else and clarify this before I go bonkers. I just called back and was told the same and more. seems that if you have medicare D your dr office should call your provider and get pre approval for speciality drug . other- wise if they just call a speciality pharm 1st you may only get 30 day supply while pharm gets the approval. Im getting dizzy with all this. I could have asked for pre authorization and they would fax dr, but I didnt. I left message on dr's machine to call , as I have the number they should call. Michaele I have to leave this alone for a while confuse

-- Edited by Michaele on Friday 7th of March 2014 04:53:38 PM

Tig · Admin

Michaele,

Thats a good start! There are several more organizations that are there to help. Be sure to contact Gilead's "SupportPath" program representative. They offer a coupon program that helps cover your co pay and deductible costs. Don't let it overwhelm you! One day and one call at a time. This is a fact finding mission right now. It's going to be fine! Have faith!!

Tig

GILEAD/SOVALDI:

http://www.gilead.com/responsibility/us-patient-access

1.855.769.7284

Michaele · Guru

Hi Tig , called ; applied over phone for assist. It isnt instant approval, but she said she thought I qualified. They have to fax papers to Dr and I have to give copies of all insurance cards and income awards: SS disability for Dr to send in when I sign the papers. Dr has to send Dx and requests, and proof of my ins and $$ info. They only pay out $3000.00 for the year, but in the event they run out of funds its just $900. Also some pharms wont bill them and they reimburse pt. Hope I dont have to borrow on my house. One must reapply every 120 days. Im more confused then ever, maybe I should have talked to the nurse first. Now Im going to call AARP Part D back and find out what the copay is. Thanks Michaele

PS; This1-855-512-3861 doesnt seem to be as good as the Pan first mentioned , I hope to get this sorted out soon.

-- Edited by Michaele on Friday 7th of March 2014 02:57:54 PM

Michaele · Guru

Hey Tig, I'll call that number at 9am when they begin thier hours. Again thanks.

Tig · Admin

Michaele,

I found another number and added it to the PAN information on the forum. This is a direct number to the Patient Advocate Foundation's Co-Pay Relief program. It should save you a few steps in the morning. It has an online application, which right now should simply provide you with more knowledge of the requirements, etc. I'm in the process of discovering what's available out there for everyone. As I find more information I will be adding it to the original list and I hope that it is beneficial to everyone here. Let me know what you find out tomorrow!

http://www.patientadvocate.org/help.php?p=905

Direct number: 1.866.512.3861 (Option 1)

Michaele · Guru

Tig, missed RN call back, she left message saying they had to file a letter of medical intent, and wanted to get everything in order before getting back to me. She made a few calls/inquiries , she said I should be able to get RX soon. someone would call me and she would call tomorrow, they are closed on Fridays , so I doubt she will. PAN was closed when called them. So I'll try in morning. Im very confused about who's pharmacy I use. Im hoping to speak with a PAN assoc before anyone calls me back. I want to thank you again for helping me so much. Michaele

-- Edited by Michaele on Thursday 6th of March 2014 11:28:01 PM

-- Edited by Michaele on Friday 7th of March 2014 12:26:02 AM

Michaele · Guru

Thanks again Tig, I'll be on it later or tomorrow . Michaele

-- Edited by Michaele on Friday 7th of March 2014 12:25:15 AM

Tig · Admin

Michaele,

You've had quite a lot on your mind, don't be hard on yourself. That's what we're here for, to help! I want you to call that toll free number below and talk with one of the assistance coordinators. They will be able to explain everything and will be able to give you detailed instructions on what they can do. You don't have to be on treatment to get the answers you need. They are very helpful people. Just relax, one step at a time. You're doing fine smile

Tig

Michaele · Guru

Thanks again Tig, Im still not thinking right. So call Pan get all info ; then let dr know? Im so confused I must seem dumb as a rock

Tig · Admin

I would definitely contact them in advance. They also have a newer program that claims instant approvals, that would certainly be worth investigating!

http://panfoundation.org/news-article-list/328

866.316.7263

They have been very helpful to so many people. Don't forget that even though you get help from one organization, you're still eligible for help from the others. Very often you'll get a larger copay assist from one versus another. They may be willing to offer recommendations and suggest a primary and secondary based on their limitations and opportunities. Some will pay a higher copay based on your deductibles, etc. Their assistance coordinators will be able to direct you and often will do much of the pre authorizations for you! I'm always amazed that these organizations sole purpose is to help you regain your health and are willing to help you pay for it! Life can be very good!

Tig

Michaele · Guru

Hey Tig , just put the PAN site on my tool bar, until I can think more clearly;baby steps for now. is the object to contact them first? I suppose I could call them and ask for protocal. All very exciting. Thanks bunches. Michaele

Michaele · Guru

Tig thanks, will get on it soon Michaele

Tig · Admin

Michaele,

If you can get past the initial authorization and before you make any agreements to start or order these medications, go to our Knowledge Base thread and contact the appropriate organizations/manufacturers payment assistance programs we have listed there. They likely will be able to assist or absorb those copays and deductibles for you. Many of the Medicare copays and deductibles are in the thousands for this tier of medication. If I can help you with this, please let me know. Good luck!

Tig

Michaele · Guru

Hello, I just called AARP plan D coverage and they were very nice and said all three RX are covered but need a special request and co payments are high. He looked in the system and didnt see a request from my dr. He asked me if I wanted to make the request my self and have them send paper work to my dr to fill in her special request. Told him I would call dr office first to see whats up;with no request being sent. Now Im waiting to hear back from nurse. They are closed on friday, but hopefully will call back today before 4pm Michaele Good Luck To All Takers

Michaele · Guru

Phew, thats alot to digest. Appears alot of you know your facts .Thanks again. Michaele

Tig · Admin

Individual allowances Michaele. When the state and fed. governments annual "budgets" or planned distributions were established for this fiscal year, these new HCV drug costs specifically, weren't factored into it. Even though the overall cost savings to cure this at the earliest stage possible is the wisest choice, the money doesn't exist in the current coffers to cover the additional strain on their budgets. They may even encourage doctors to utilize the less expensive older SOC's until such time as the funding becomes more readily available. I think it's going to be a battle of the accountants to determine where these extra funds will come from.

Tig

Michaele · Guru

Hi Tig56, thanks. Didnt know that, With all the boomers, they better get it fixed fast. Did u mean the system would run out of funds or the individual allowance? Michaele

PS; Im not thinking right, my ex is dying up in Chgo; has 48hrs or less.

Tig · Admin

One other thing, there is a current study or investigation being done regarding these government programs. Namely Medicaid, and Medicare. Seems that these new meds were released after state allowances were decided for 2014. If payments were to be authorized for these expensive drugs at this stage, the funds allotted for this calendar year would be immediately exhausted. Until alternative funding sources can be found, I would expect to see a lot of initial denials.

Tig

Tig · Admin

Here is a list providing links to several payment assistance programs:

http://hepcfriends.activeboard.com/t56904226/payment-assistance-programs/

Tig

PS: Don't forget to utilize the search function here on the forum! It has much of the information you're seeking. Good luck!

Michaele · Guru

Thanks again. had Hep c since early 1970s class1-2 stage 2-3, so waiting is not a good idea . Started to bridge around portal vessels. But Im good. michaele

OldenSlow · Senior Member

Oops.. Forgot to list the PAN Foundation ph.# - 1-866-316-7263

I might suggest being as proactive as possible with all parties, Michaele. With all of the current commotion over cost, coverage, mid-treatment denials etc., the future of coverage is more than a little unknown at the moment. You may even have the option (depending on physical status) of waiting until later in the year, when newer (better?) treatment is expected to be FDA approved. Still, I expect it will be preposterously expensive as well, and provoke further problems in the coverage/payment arena. Regards..

wayne

Michaele · Guru

Hi OldenSlow , thanks for info. Dr office was to have sent request for Rx TX 1st wk of Feb.2014 , I havent heard a thing and dont want to bother Dr's nurse with to many questions. I suppose I should call and ask if they have heard anything. Thanks for reply Michaele

OldenSlow · Senior Member

Michaele - I would think it dependent on your Medicare Part D provider. Speaking with them might be a good place to start. But I'd also strongly suggest that you contact the payment assistance programs provided by both Gilead (Sovaldi) and J&J (Olysio). Their copay coupons may apply only to private insurance, but there is further assistance available. I've spoken to both companies via phone on other matters and found them to be co-operative and helpful.

Gilead: 1-855-769-7284 J&J: 1-800-652-6227

Also.. Check out the PAN Foundation. Gilead has made a contribution to them for copay assistance. Sovaldi and Olysio are both listed as available for coverage. You could go through the online application process and see what you can fiind out about it all.

https://www.panfoundation.org/fundingapplication/medicationCovered.php

Best of luck...

Michaele · Guru

Does anyone know if the boomers on Medicare Part D are covered for new non interferon drugs. I thought I read yes , then no , then alot of iffy bits. And also if you have Medicare D you are not eligible for asst with cost from drug companies. All response welcome. Thank you Michaele

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