Insurance News

Just as it is a given that the sun will rise each day, we also know that the world of reimbursement for hemophilia products and services is ever -changing. One thing has remained constant though, u&i Inc. is still registered with and approved by NYS Medicaid.

Even though most prescription medications have been moved to managed care, clotting factor (at least for the foreseeable future) is billed as fee for service. This may sound confusing however it simply means that for the time being, New York State Medicaid will continue paying for the clotting factor products themselves rather than the managed care provider. Additionally this means that u&i can continue to serve the factor needs any and all NYS Medicaid customers.

To this end, check out the updates found on this page. If you have questions or concerns, and are unable to locate the answers here, contact us. YOU are the most important part of u&i!


Manufacturer Factor Assistance

& Free Trial Programs

Manufacturer Program Description Rating
Baxter CARE Program This program offers free Baxter clotting factor products to individuals with a current prescription for that product, so long as the individual has no insurance. It does not matter if the individual has been on a baxter product in the past or not. The participant must report monthly and show that they have been trying to acquire health coverage. ****
Freedom of Choice The freedom of choice program is set up for an individual to receive 6 doses of Advate free of charge so that the individual can try the product. Good side; this provides six doses, regardless of how high that dosage is. Down sides; the Freedom of Choice program is available only to individuals not currently using Advate, provides only 6 doses, even if the doses are small, and is available only one time per individual. ***
Bayer Factor Solutions Co-pay Assistance Program

Bayer offers a savings program that can help cover co-pays. The savings cannot be used with factor covered fully or in part by any state or federal health insurance program. This program caps at $6000.00 annually and cannot be used for deductible or any other out of pocket costs other than co-pays.

This program is not limited by the number of uses but does run out at the end of the year. The program is on a first come - first serve basis and does not require the patient to pay part of the co-pay before it kicks in.

Free Trial Program Bayer's free trial program provides up to 6 free doses of Kogenate FS (not to exceed 20,000iu) to previously treated patients and up to 5000iu for newly diagnosed patients. Good side; Patients can get some Kogenate FS to try. Down sides; Only available to individuals not using Kogenate; restricts the amount of factor one can receive in several ways. **
CSL Behring Assurance Program A program designed to help people who have a lapse in their insurance policy continue with there current therapy. Only available to US citizens, CSL issues a certificate to patients using a CSL bleeding disorders product for every 3 months the person uses the product. If the individual loses insurance coverage in the future, they can cash in one certificate for a free month's worth of factor until they have no certificates left to use. ***
My Access

A program designed to help with the out of pocket costs associated with treatment with Helixate. Residents of the US who do not have any federal or state insuance are eligible as long as they have a current prescription for Helixate and some form of non-governental insurance. Patients must reenroll every year if they desire to keep receiving the assistance. Once enrolled and approved, the patient is issued a prepaid Mastercard that can only be used for CSL Behring's bleeding disorders products such as Helixate, Humate P and Corifact.

This program is not limited to co-pays and may be used for deductibles. Currently the program caps at $12,000.00 per year and has no limits on the number of times that card is used in a year.

Patient Assistance CSL's Patient Assistance Program allows for three months worth of free factor to qualified individuals that either lack insurance or are underinsured. Patients qualify through submitting a form along with statements from their doctor. After the three months worth of factor has been used, the patient may be re-evaluated and qualify for three more months. there is no limit to the number of time an individual may re-qualify. ****

Alphanate Savings Card Program

Alphanine Savings Card Program

The Alphanate and Alphanine Savings Card Programs issue a prepaid Mastercard for $500 that can only be used for co-pays and deductibles for Alphanate or Alphanine costs. This program is only available to people with a current prescription for Alphanate or Alphanine and cannot be used in conjunction with any state or federal insurance program.

The pharmacy in which the card is used must be enrolled in the program and as a qualifier, the patient must submit an EOB to Grifols. This program cannot be used retroactively and will begin once the EOB has been processed.

GAP Program Grifol's Assurance for Patients (the GAP program) is a temporary assistance program meant to help individuals who lose their insurance until their new insurance is started or they qualify for Medicaid or Medicare. To participate, the individual must have been on a Grifol's product for at least 3 months prior to losing their insurance and have a current prescription for that Grifol's product. ***
GPA Proram Grifol's Patient Assistance Program (the GPA Program) provides Grifol's clotting factor products to individuals with a current prescription for that product and no insurance coverage. In order to participate in the GPA program, the individual must; be a US citizen, must not be eligible for state or federal assistance (Medicaid or Medicare), and must be below 250% of the Federal Poverty Level. ****
Novo Nordisk SevenASSIST Novo Nordisk's SevenAssist program is only a temporary help in the way of factor itself. Patients who qualify are eligible for up to 300mg of NovoSeven. This translates to roughly 40 doses for a 180lb individual. What makes this assistance program stick out is not the factor assistance but the other perks. This program can help with various other parts of life as well. The SevenASSIST program also boasts about assisting people through educational grants and medical expenses (such as dental work, mobility devices, travel to meetings and conferences, and other medical aid devices). *****
Pfizer Rx Pathways Rx Pathways is Pfizer's factor assistance program. This program provides free Pfizer factor products to individuals who are uninsured and have a prescription for one of those products. No prior use of Pfizer's factor products is needed. This program also covers people who are insured with support services and even a Hardship Assistance part, where people who can show inability to afford the product, Pfizer can assist with free factor. Participants are required to re-enroll annually. *****
Factor Savings Program

Pfizer offers a savings card that can help cover co-pays. The savings card cannot be used with factor covered fully or in part by any state or federal health insurance program. This program caps at $5000.00 annually and cannot be used for deductible or any other out of pocket costs for Xyntha or Benefix other than co-pays.

This program limits use to one time per month (meaning if you receive factor monthly, additional fills for either break through bleeds or procedures will not be eligible). The co-pay assistance offered is only for co-pays that exceed $10 per month as the patient is responsible for the first $10 of co-pay under this program.

Trial Prescription Programs Pfizer will supply eligible patients with up to 20,000iu of either Xyntha or Benefix (depending on the bleeding disorder) in order to allow the individual to try the product. Good sides; since they provide 20,000iu, this could easily be an entire month's worth of factor for a low volume user; Pfizer offers both Factor VIII and IX with their trial programs. Downsides; Patient cannot already be using a Pfizer product; If the individual is a high volume user this could be 5 doses or less. ***
** The ratings are solely the opinion of U&I Pharmacy, based on ease of use, eligibility requirements and amount of assistance available through the individual program. This Assistance Guide is placed here simply for the convenience of the bleeding disorders community and in no way implies any endorsement of or responsibility for any of these programs. For more information on any of these programs or the literature about them, please feel free to contact us at (315) 829 - 3604.


Other Resources
Insurance, Reimbusement, & Factor Assistance Resources
Additional Resources:

The Partnership for Prescription Assistance
The Partnership for Prescription Assistance helps qualifying patients without prescription drug coverage get the medicines they need for free or nearly free.

Patient Advocate Foundation's CO-PAY Relief
Willing to help with co-pays for Hepatitis C Medications up to $3,000.00 for those who qualify. Eligibility requirements are; Must be within 500% of the national poverty level; Must have Hepatitis C; Must currently have insurance that cover the medication; and Must live in the United States.