Rheumatoid arthritis (RA) is a chronic disease that requires ongoing medication and treatment for the majority of patients. Many of these treatments are highly effective and can stop the disease’s progression, preventing further joint damage.
However, specialized medications like disease-modifying antirheumatic drugs (DMARDs) and the newer, more expensive biologics can create an affordability concern. This leaves many patients wondering how they will be able to afford their personalized RA treatment over the long-term even if they are covered by health insurance.
Fortunately, there are a number of assistance programs available both privately and through the government to help patients struggling with paying for RA treatment.
Specific drugs for RA can add up to thousands of dollars annually in some cases. Biologics, for instance, are the newest immunotherapy drugs which can be highly effective for many patients. These drugs, however, can cost patients between $1,300 and $3,000 per month.
Many patients choose not to pursue biologics due to their expense, and instead opt for conventional DMARDs, which are more affordable. Additionally, patients who require physical or occupational therapy or special devices and/or products for mobility are also typically paying those expenses out of pocket.
As paying for RA treatment long-term becomes an escalating concern among many patients, there has luckily been an increase in options available to help relieve some of the financial burden that can be accrued over time.
Whether you are insured, underinsured or not insured at all, there are options available to provide financial assistance for patients paying for RA medications. Some options are available through the government, while others are available directly through the drug manufacturers and various pharmacies. There are also several independent organizations, such as nonprofits, which provide financial assistance to eligible patients.
Below are listed some of the private and government financial assistance options available to people struggling with paying for RA treatment:
Many of the drug manufacturers have financial support programs in place to help patients pay for the copayments or cover a portion of copayments at the pharmacy. Some of them also provide additional financial options for families who aren’t covered by health insurance at all.
These drug company rebates are usually referred to as Patient Assistance Programs. The level and length of coverage are dependent on the brand of drug and its manufacturer. Over 30 RA drug brands offer financial assistance to patients. These include a variety of medications from biologics to prescription NSAIDs.
For example, Enbrel, a common biologic drug for RA, provides an Enbrel Support card to eligible underinsured patients. It covers the drug costs for the first six months, then the following six months covers out of pocket expenses above $10 per month and up to $4,000 per patient in a six-month period. Enbrel Support can be renewed annually for eligible patients.
NeedyMeds is a non-profit organization that provides a variety of resources to medical patients. You can search on their website for discounts by medication brand name, medication generic name, diagnosis, and many other criteria. They have links and listings for everything from government programs to scholarships to rebates to transportation assistance.
One of their most popular and impactful programs is the NeedyMeds Drug Discount Card. This card is available to all patients and allows them to receive up to 80% off their prescription medications at participating pharmacies in the United States. The card is free and available to everyone. One family can use the same card.
The NeedyMeds Drug Discount Card is helpful for uninsured patients who are paying for RA treatments out of pocket. While it doesn’t work in conjunction with copayments, the discounts provided through NeedyMeds may sometimes end up being better than what some insurance plans offer. It is in your pocketbook’s best interest to do a little “homework” and research ways to help decrease your out of pocket medical expenses. Every little bit helps!
Good Days is an organization formerly known as the Chronic Disease Fund. Good Days works directly with physicians and pharmacies to pay for patients’ out of pocket expenses. Good Days provides support to eligible patients requiring financial assistance to pay for their biologic (Cimzia, Humira or Remicade) medications.
The Assistance Fund is a non-profit that provides of variety of financial assistance support programs to eligible patients suffering from critical and chronic diseases, including RA.
The Assistance Fund provides support through three different types of programs: Copay Assistance Programs, Financial Assistance Programs, and Health Insurance Premium Assistance programs. For eligible RA patients, The Assistance Fun can provide support for prescription drug copayments and deductibles. The Assistance Fund provides financial assistance for specific medications, including biologics like Enbrel, Humira, and Remicade.
The Patient Access Network Foundation is an organization that works to financially support underinsured patients suffering from life-threatening and chronic diseases. The Patient Access Network pays for eligible RA patients’ out of pocket medication and treatment expenses. It covers a variety of RA medications including many brands of biologics.
Many states provide financial assistance to patients through pharmaceutical assistance programs under Medicare and non-Medicare eligibility. To find out which states offer pharmaceutical assistance programs, search the Medicare website.
Medicare is a federal health insurance program that provides low or no-cost health coverage for eligible patients. In general, Medicare is available to those aged 65 and older, as well as disabled people under the age of 65. Medicare has a number of plans available including Part D Drug Coverage for prescription pharmaceutical treatments.
Medicaid is a federal health insurance program administered at the state level. Each state has its own eligibility criteria and determines the scope of services provided. Generally, financial assistance applies to low-income families with limited resources. Though the program administration differs from state to state, many of the programs cover prescription drug costs, clinic and physician services, as well as physical therapy.
There are many programs and organizations available to help support RA patients in need of financial support. Be sure to speak with your healthcare team about any financial concerns. Your doctor or rheumatologist may be able to suggest programs and offer assistance in order to ensure you get the personalized treatment that you need. Your rheumatologist may also suggest generic brands or other types of drugs that may be just as effective for your particular case which are available at a lower cost to you.