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ADAP ADVOCACY ASSOCIATION 2013 HIV/HCV CO-INFECTION SUMMIT

ADAP ADVOCACY ASSOCIATION 2013 HIV/HCV CO-INFECTION SUMMIT. Lynda Dee Fair Pricing Coalition PAPS & CO-PAY PROGRAMS. FAIR PRICING COALITION. Martin Delaney Linda Grinberg 1999. FAIR PRICING COALITION. FPC History Programs and Initiatives Common Form, HarborPath, Welvista

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ADAP ADVOCACY ASSOCIATION 2013 HIV/HCV CO-INFECTION SUMMIT

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  1. ADAP ADVOCACY ASSOCIATION 2013 HIV/HCV CO-INFECTION SUMMIT Lynda Dee Fair Pricing Coalition PAPS & CO-PAY PROGRAMS

  2. FAIR PRICING COALITION Martin Delaney Linda Grinberg 1999

  3. 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

  4. 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

  5. FPCPROGRAMS & 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. ABBVIE CO-PAY PROGRAM • Covers first $50 of Norvir • Covers first $200 of Kaletra • Online & healthcare providers

  18. BI CO-PAY PROGRAM • Coverage after the first $25 paid • Covers Viramune XR, not IR • Does not cover Aptivus • Providers, ASOs and pharmacies

  19. BMS CO-PAY PROGRAM • Covers first $200 Reyataz/Sustiva • Covers first $400 for Atripla/Gilead • Online or healthcare providers

  20. 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

  21. GILEAD CO-PAY PROGRAM • Covers first $400 for Atripla, Complera and Emtriva • Covers first $200 for Emtriva, Truvada and Viread • Providers, ASOs, pharmacies

  22. JANSSEN CO-PAY PROGRAM • Coverage after first $5 paid • Prezista, Intelence, Edurant • Coverage unlimited thereafter • Online or healthcare provider

  23. 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

  24. VERTEX CO-PAY PROGRAM • HCV only • $10,000 for Incivek • No income limit • Vertex or pharmacies

  25. ViiV CO-PAY PROGRAM ViiV (Formerly GSK & Pfizer): • Covers first $200 • Online or healthcare provider • Must re-enroll for 2013

  26. FAIR PRICING COALITIONfairpricingcoalition.org Bill Arnold Bill Arnold Paul Arons Bruce Burkett Jeff Berry Ryan Clary Lanny Cross Lanny Cross Lynda Dee Lynda Dee David Evans David Evans Murray Penner Michael Ninburg Murray Penner Lorren Sandt

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