← Return to Financial discussions/tips concerning expensive treatment

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@hopefullibrarian

@ans Thank you so much for bringing together important information about all types of assistance, where everyone can share their invaluable experiences navigating the financial challenges of paying for expensive Rx treatments.

If you're under 65 without Medicare cover, you may find the thread linked below helpful.
https://connect.mayoclinic.org/discussion/any-leads-on-rx-payment-assistance-for-under-65s/

I'll also duplicate the content to-date from that thread in this one, so that it's all here in one place for everyone.

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Replies to "@ans Thank you so much for bringing together important information about all types of assistance, where..."

The following entries are copied from the "Any leads on Rx payment assistance for under 65s" thread:

On 11/8/23 @hopefullibrarian said:
Radius Assist for TYMOS (abaloparatide) injection therapy. Here's the link to the page that where you can access the application and review the eligibility requirements. https://radiuspharm.com/radius-assist/ You can call as well 1-866-896-5674.
Radius also offers a discount card. I don't yet know any more about it than what's in the fine print on the back side. Click here for the printable version: https://svc.opushealth.com/TymlosPOD/Documents/WebDOC84dd3bcf-deea-4b64-a02d-988b582c8080.pdf

On 11/9/23 @hopefullibrarian said:
Amgen Safety Net Foundation is a non-profit patient assistance program for Amgen medications. This includes Evenity. Like Radius Assist for TYMLOS, Amgen Safety Net Foundation has eligibility requirements. If approved, they cover 100% of the cost. Here's the link to their site: https://www.amgensafetynetfoundation.com/index.html

On 11/9/2023 @katwhisperer said
I'll briefly summarize what I posted elsewhere re: Radius Patient Savings Card (for Tymlos), in case it helps anyone. This is based only upon my personal experience using the program in 2023. (Program eligibility and rules often change, so hopefully others chime in w/their updated experiences at some point.)

1. They offer a set $ per year, loaded to your Patient Savings Card.
2. You must have commercial insurance to qualify, (like through your job or insurance you buy yourself.) Govt funded insurance (medicare, Tricare, VA not eligible.)
3. It won't cover 100% for everyone: once you deplete card's set amount, you then pay out of pocket.
4. WHEN you hit that out-of-pocket scenario depends upon your own insurance. Some get through most or all of the year free. Others are out of funds midway.
(As an example, I am billed $2600/month retail for Tymlos until I meet my 3k deductible. Then my insurance pays a portion and I pay $700/month (yes – that's the discounted rate through insurance, lol.) My Radius funds were depleted in Aug. Paying out of pocket for rest of 2023.
5. Radius only approves 1 card for you. You have to wait until the end of the calendar year to find out if they are offering the program again next year and if you can get another card. They won't say in advance.
6. If it does continue and you are approved for a 2nd card, you get another 6 months only: the "lifetime" maximum is 18 months TOTAL.
So realize you may need a "Plan B": $ from other patient support programs or paying out of pocket for what Radius and your insurance won't cover.
I don't earn a lot, but had zero luck finding other funding. Patient programs require very low income to qualify, unless one has kids/dependents living at home or already on other govt support like food stamps.
My doc won't like it, but I'll have to switch from Tymlos to a maintenance drug next yr if I can't get a 2nd card.
Good luck to everyone. It sure is a costly drug!

On 11/9/23 @hopefullibrarian said:
Before reading this, please note that Rx assistance programs can be a literal life saver. The following information is provided to help you avoid potential pitfalls. Be informed. Do your research.
If you don't already know about Copay Accumulator & Maximizer Programs, this should be an eye-opener. It was for me.
In the "Is anyone using Tymlos" discussion, @kjoy and @windyshores shared some VERY IMPORTANT information in regards to who benefits from any assistance you may receive. https://connect.mayoclinic.org/comment/959417/
Depending on the nitty gritty of your insurance policy and the laws in your state, your costs may not be reduced at all. @kjoy shared the following very helpful links. I'm sharing them again here.
Here is an explation. https://old-prod.asco.org/sites/new-www.asco.org/files/content-files/advocacy-and-policy/documents/2021-AccumulatorsPolicyBrief.pdf
And here is a section of this page: https://www.crohnscolitisfoundation.org/managing-the-cost-of-ibd/hot-topic-copay-accumulator-maximizer-programs#:~:text=As%20of%20summer%202023%2C%2019,as%20well%20as%20Puerto%20Rico.
I'm sure no one wants to find that you put in a ton of work seeking out and applying for assistance only to find your insurance company saves money, but not you.