Winter 2008 | Understanding Factor Assistance Programs / Joshua M. Moore

As the hemophilia community begins to worry less about the treatment of bleeds and staving off joint damage, our eyes focus more and more on the insurance industry, factor cost, and of course, lifetime caps and how to avoid exceeding their limits. Our worries are not unjustified either: According to the National Hemophilia Foundation, over 3,000 people in the United States each year exceeds their lifetime insurance cap,* leaving them virtually without care.

As the cost of factor continues to rise, the average cost for hemophilia therapy has increased to nearly $200,000 per year. The National Hemophilia Foundation goes on to claim that these individuals will easily exceed their lifetime insurance cap within five to ten years.*

Increased knowledge of one’s own health insurance policy and Factor Assistance Programs have thus become an outlet for the hemophilia community to avoid the fate of losing the health insurance upon which we stake our lives.

The following is a list of the factor manufacturers, their products, factor assistance programs, phone numbers, and web addresses for more information. By writing this article, I have learned a great deal about my own situation and hope that the information provided will help someone else understand more about this very important topic.

* http://www.hemophilia.org/news/legislative/lu_lifetimecaps.htm

Baxter Healthcare
Product: Advate
Website: www.hemophiliagalaxy.com/therapies/reimbursement/factor_assist.html
Recombinate Phone #: 800-548-4448
Hemofil-M
Feiba-VH

1. Factor Assist Program
Product requirement: Yes, must be using a Baxter product
Income requirement: None

How it works: Essentially a “safety net” program for those who already have insurance. When you have used any of Baxter’s hemophilia therapies for a continuous year and collected four certificates, you can redeem the certificates for a three-month supply (based on your usage) of factor if you have an insurance lapse. Up to 16 certificates (representing four years of continuous use of Baxter therapeutics) can be collected and redeemed, meaning you will receive up to 100,000 units of factor should your insurance situation ever require it. Your certificates are good for five years after you receive them.

2. Factor Plus Program
Product requirements: Yes, must be using a Baxter product
Income requirements: None
How it works: This program is dedicated to those who are currently without insurance. While using this program, Baxter will work with you to obtain insurance to pay for the factor. Until then, a maximum of 100,000 units can be used in a three-month period free of charge.

Wyeth
Product: BeneFIX
Website: www.hemophiliavillage.com/programs_insurance.asp
ReFacto Phone #: 888- 999-2349

1. Insurance Coverage Program
Product requirement: Yes, must be using a Wyeth product
Income requirement: None
How it works: A patient must use a Wyeth product for at least three months of consecutive use before they are eligible for this program. In the event of a lapse in your insurance coverage, you will be eligible to receive a one-month supply of factor during such lapse, up to twelve months or a maximum of 200,000 units.

2. Patient Assistance Program
Product requirement: Yes, must be using a Wyeth product
Income requirement: Less than $25,000 (single) or
Less than $40,000 (2 + adult family members)
How it works: A patient without health insurance or government assistance is eligible for this program. One can redeem up to a maximum of 75,000 units of product free.

Bayer Biologicals
Product: Kogenate FS
Website: www.hemophiliabayer.com | www.kogenatefs.com
Phone #: 800-288-8374

1. Patient Assistance Program (PAP)
Product requirement: None
Income requirement: Three times the federal poverty limit
How it works: Bayer’s Patient Assistance Program is perfect for gaps in one’s insurance. Upon signing up for the program, a patient will be eligible to receive up to three months of free factor totaling no more than 90,000 units. If insurance is still a problem, a patient may re-apply for the same 90,000 units of factor in a second three-month window, essentially giving them six months of free factor. There is, however, a maximum of 180,000 units of factor per year on this program.

2. KogenateFS Reliance Program
Product requirement: Yes, must be using KogenateFS.
Income requirement: None
How it works: Upon using their product, Bayer recommends signing up for this program immediately in order to reap its rewards sooner. After one uses the product for three consecutive months, they are automatically eligible to receive one month of free factor (up to 30,000 units).

Novo Nordisk
Product: NovoSeven
Website: http://www.novoseven-us.com/patient/sevenSecureWhatIs.aspx
Phone #: 877-NOVO-777

1. SevenSecure Program
Product requirement: Yes, must be using NovoSeven
Income requirement: None
How it works: SevenSecure is a program for those without insurance. Once enrolled, a patient may redeem 300 mcgs of NovoSeven or six-month’s worth of NovoSeven free of charge (whichever expires first). If a patient has insurance but is within $50,000 of their lifetime cap, they may also redeem the same amount. Novo Nordisk will also assist in your insurance woes and they are actively participating with PSI to issue medical grants and scholarships.

CSL Behring
Products: Helixate-FS
Website: www.zlbbehringassurance.com
Monoclate-P Phone #: 800-676-4266
Humate-P
Mononine

1. Assurance Program
Product requirement: Yes, must be using a CSL Behring product
Income requirement: None
How it works: Once enrolled in the Program, you will begin earning an Award Certificate for every three consecutive months of product use. Each Certificate is worth a complimentary, one-month supply of product up to the maximum amount redeemable. You can redeem up to a year’s worth of product (representing twelve Certificates or three years of continuous product usage) or just one-month’s worth of product - it all depends upon your needs and upon the length of your insurance gap. Note: There is both a quarterly and a yearly maximum for each of their products and goes as follows:
Quarterly maximum: Helixate / Monoclate = 36,000 units. Mononine / Humate = 18,000 units.
Yearly maximum: Helixate / Monoclate = 144,000 units. Mononine / Humate = 72,000 units.

2. Patient Assistance Program
Product requirement: Yes, must be using a CSL Behring product
Income requirement: None
How it works: CSL Behring is willing to donate an unspecified amount of product to those in need that are without health insurance. It is supply-based and is without requirement, except that one must reside within the United States.

Grifols
Products: Alphanate
Website: www.grifolsusa.com
Alphanine-SD Phone #: 888-GRIFOLS
Profilnine-SD

1. Grifols Assurance Program
Product requirement: Yes, must be using a Grifols product
Income requirement: None
How it works: Helps protect a patient with insurance against gaps and breaks in their insurance. After three months of continuous use of a Grifols product, one may redeem up to 100,000 units of factor for free each year. Must be without insurance at the time of redemption.

2. Grifols Patient Assistance
Product requirement: Yes, must be using a Grifols product
Income requirement: 250% of federal poverty limit
How it works: A maximum of 100,000 units of factor may be redeemed on this program. It is for those who are without insurance.

Talecris Biotherapeutics
Product: Koate-DVI
Website: www.talecris.com
Phone #: 919-316-6300

Talecris is currently working on a program for their patients, but at the moment does not operate an assistance program. Talecris has mentioned that it will eventually help with out-of-pocket expenses and assist patients in recovering their lost insurance.