Since biologics were introduced in 1998, they have helped many people with rheumatoid arthritis function better. Two out of three people treated with biologics, which must be injected or given intravenously (through an IV), do well on them.
However, biologics are quite costly. They can range from $12,000 to $30,000 a year. Biologics are pricey because they are costly to produce. Biologics are genetically engineered medications made from living organisms. The raw materials needed are expensive and the manufacturing process is more complicated than other types of drugs.
Many health insurance plans will cover at least some of the cost. You need to check with your insurance company to find out whether it has any special requirements. For example, your insurance company may reimburse you differently for drugs given by injection or IV.
Some insurance plans will require you to get prior authorization before you receive injectable or specialty medications and are reimbursed for them. Also, if you are thinking of switching insurance plans, check to see whether coverage of your biologics will change.
Reducing Costs: Help From Manufacturers
Manufacturers that make these powerful drugs have a variety of programs that help people pay for their RA biologics. If you don’t have insurance or have a limited income, you are likely to qualify for their assistance.
You can find more information about eligibility and how to apply for assistance at these manufacturers’ websites:
Bristol-Myers Squibb Patient Assistance Foundationwww.bmspaf.org
Abbott Patient Assistance Foundationwww.humira.com/global/financial-assistance.aspx
Kineret Patient AssistanceProgramwww.kineretrx.com/professional/reimbursement/reimbursement.jsp
Certolizumab Pegol (Cimzia)
Cimzia Co-Pay Savings Cardwww.cimzia.com/savings/
Amgen/Pfizer ENcourage Foundationwww.encouragefoundation.com/index.jsp
Johnson & Johnson Patient Assistance Programwww.jjpaf.org
Actemra Co-Pay Card Programwww.actemra.com/actemra/rheumatoid-arthritis/financial-assistance.html
Reducing Costs: Help From Nonprofits
A number of nonprofit programs are available to help people who can’t afford their medications:
P.O. Box 219
Gloucester, MA 01931www.needymeds.org
NeedyMeds is an information resource that helps people who cannot afford medication or healthcare costs find programs that can assist them. You don’t have to identify yourself and may be able to get help free of charge.
The Patient Advocate Foundation
421 Butler Farm Road
Hampton, VA 23666
The PAF offers a Co-Pay Relief Program that provides financial assistance to insured patients, including those who are Medicare Part D beneficiaries. However, you must qualify financially and medically to access its medication copayment assistance. Call counselors will help guide you through the enrollment process.
11608 Darryl Drive
Baton Rouge, LA 70815www.patientassitance.com
PatientAssistance.com is a good resource if you can’t afford your prescription medications and need help from a patient assistance program.
111 Brewster Street
Pawtucket, RI 02860www.rxassist.org
Created by Volunteers in Health Care, a national, nonprofit resource center for the uninsured, this site provides information and a database to help you find out how to get affordable or free medications.
Reducing Costs: Help From Your Doctor
Your doctor might know of additional resources, so don’t be shy about asking. It’s important that you get the medications you need. The earlier you receive treatment for RA the better your results.