Any leads on Rx payment assistance for under 65's?

Posted by hopefullibrarian @hopefullibrarian, Nov 7, 2023

There are many of us out there who aren't 65 yet, don't qualify for medicare, and need expensive osteoporosis treatments that we can't afford.
Several assistance programs exist. This discussion can make it easier to find them.
There are existing discussions/threads here that include useful information on this topic. Here's a recent example: https://connect.mayoclinic.org/comment/952838/
It will be nice to bring it together in one place.
Please use this discussion to share and to learn about programs that offer assistance for osteoporosis prescriptions.
Thank you to @windyshores for suggesting we start a discussion on this topic.

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

I'll kick things off with 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

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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

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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!

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@katwhisperer

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!

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That's not cool that you can't finish your treatment. Sadly, this sort of dilemma happens all the time. Hopefully, the treatment you did receive proves to have been worth the high cost.
I'm in the process of finding assistance and can only share what I learn as I go along. Whereas, details of your first-hand experience are invaluable. As you said, "...realize you may need a "Plan B".
Thank you!

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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.

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I am on Fossomax ,tramadol and gabapentin and was told to sign up for a free Goodrx card ( I don't have any insurance) and it saves me a fortune. I have to pay for my office visits, but my medicnes are incredibly reasonable this way, you just have to ask if your pharmacy accepts it, if not call around. I have never had a problem finding a pharmacy that will accept it. I am also able to use it for my pets medicines. Just google Goodrx.

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The manufacturer of the generic for Forteo has an assistance program. Alvogen offers a savings card for Teriparatide. Per the Terms and Conditions, "Eligible patients can pay as little as $0 and receive up to $12,000 off the patient’s co-pay or out of pocket expenses annually..."

Here's the link: https://www.alvogenteriparatide.com/savings-program

Thanks to @vkmov for sharing info about the Forteo savings card. Here's a link for anyone who wants to explore this option: https://www.forteo.com/savings-and-support

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@hopefullibrarian

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

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I'd like to have Tymlos treatment, but that's not on the cards for me at the moment. I decided to try for Evenity instead. My doctor is completely on-board, so I started the process of applying to Amgen Safety Net.

To be eligible, if you're under 65 and have lived in the US for at least the last 6 months, you must either be uninsured or have commercial insurance that does not supply coverage for Evenity, and your household income must to be < 300% of the federal poverty level.

It's all surprisingly easy. I called them at 866-264-2778 and completed the application over the phone. It only took about 10 minutes, maybe less.

Now all that I need to do is get a denial of coverage on letterhead from the insurance company, and sign consent and authorization forms before faxing everything to the Foundation.

You might be interested to know how I'm getting the denial of coverage letter. My doctor is submitting a prior authorization even though we already know that Evenity is non-formulary. When they get the denial letter, I'll go and pick it up. Fingers crossed that the insurance company doesn't actually authorize the treatment. That would throw a wrench into my plan.

If you decide to apply, be aware that the consent and authorization forms give the foundation and their partners access to your health records. I'm not thrilled about that part, but it's a trade-off.

I'll post an update with what happens next.

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Thank you @dianeg77 for sharing another form of assistance available in the "Evenity Cost" thread. https://connect.mayoclinic.org/comment/999636/
It's the Amgen Support+ Co-pay Program. It's like other co-pay assistance programs where you're given a card with a benefit value that you can use towards your co-pay or co-insurance. With Evenity, the benefit amount is $8000 and you get 3 years to use it. This is available to anyone with commercial insurance regardless of income.

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