docFinancial Aspects of Treating Hepatitis C
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Financial Aspects of Treating Hepatitis C
Financial Aspects of Treating Hepatitis C Michael Ziegler Director of Specialty Pharmacy Services Good News…Treatments Are Advancing! Average S.V.R. Rates 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% IFN Only IFN + Riba Peg-INF + Riba 1997 1999 2003 Bad News…Costs Are Increasing! Average Treatment Cost for FDA Approved Therapy $25,000 $20,000 $15,000 IFN Only IFN + Riba Peg-INF + Riba $10,000 $5,000 $0 1997 1999 2003 What is Available to Help With The Cost? = Many Options Available Options P.B.M. Insurance Coverage Major Medical Insurance Coverage Medicaid Medicare Manufacturer Assistance Programs Drug Studies Cook County Hospital VA Hospital P.B.M. Insurance Coverage •Prescription “Insurance Cards” = Good Coverage •Provided By An Employer (About 80% of Insured Patients) •Might Require Prior Authorization (Extra Time) •Copays are Increasing •May Have Different Coverage Rates for Formulary Meds (Therefore, it may be cheaper for you to use one medication vs. the other) •Most PBM’s are Affiliated with a Mailorder Major Medical Insurance Coverage •Prescription Coverage as Part of Your Medical Benefit •Provided By An Employer (About 20% of Insured Patients) •Might Require Prior Authorization (Extra Time) •Patients are typically required to pay upfront for medications, and submit receipts for reimbursement. (Obviously this is difficult for almost any patient to afford. Therefore, you should use a pharmacy that bills and accepts assignment on major medical claims.) Damer & Cartwright, Priority, Chronimed, Amber, Fischer’s Are several such pharmacies. Medicaid •Medicaid is available to the elderly, disabled, families with children under 18 years of age. •Medicaid is subject to income requirements •Medicaid Recipients are offered excellent options for Hepatitis C •Every brand of the FDA approved treatments are covered by Illinois Medicaid •Labs, MD office vists, etc… are also covered by Medicaid •If you think you may be eligible for Medicaid & would like assistance in enrolling in Medicaid contact: Family Benefits Solutions: 847-279-8506 Medicare •Available to the disabled, elderly, or dialysis patients •No Income Requirements •Medicare covers MD visits, labs, hospitalization, etc… MEDICARE DOES NOT COVER MOST TREATMENTS OF HEPATITIS C •Medicare Only Covers Interferon If Administered in MD Office (Not Effective) •What to Do? Illinois Senior Care: www.state.il.us/aging •Manufacturer Assistance Programs Manufacturer Assistance Programs Peg-Assist Program: Pegasys & Copegus 877-734-2797 Commitment to Care: Peg-Intron Rebetol: 800-521-7157 Infergen Assitance: Infergen: 800-577-9112 •Typically Require No Insurance Coverage For Medication •Typically Require Income Under $32,000-$35,000 •Documentation & Requirements Vary •If approved you will receive free 12 months of treatment. www.needymeds.com www.themedicineprogram.com Drug Studies •Usually offered at U of C, U of I, Rush, Northwestern, Loyola & Some Community Offices •Will provide medications & some other costs •You will be guaranteed to receive at least the standard of care Cook County Hospital •Any Resident of Cook County, regardless of Insurance, Income, or Citizenship can receive healthcare at Cook County Hospital… Including treatment for Hepatitis C VA Hospitals •VA Hospitals Also Offer Treatments for Hepatitis C •Most VA Hepatologists are Affiliated with Major Universities Solutions for Most Patients… P.B.M. Insurance Coverage Major Medical Insurance Coverage Medicaid Medicare Manufacturer Assistance Programs Drug Studies Cook County Hospital VA Hospital … Therefore Finances Should Not Be A Reason Why You Can’t Receive Hepatitis Treatment!!!!!!! For More Info: Call the ALF @ 312-377-9030
