Copay Assistance and Help With MS Infusion Cost: Are You Eligible? | MyMSTeam

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Copay Assistance and Help With MS Infusion Cost: Are You Eligible?

Written by Torrey Kim
Posted on April 14, 2023

  • Disease-modifying therapies (DMTs) that are given intravenously for multiple sclerosis (MS) may come with a high price tag.
  • Drug manufacturers and copay assistance programs may help lower the costs of these infused medications.

Disease-modifying therapies for multiple sclerosis can be expensive. Some DMTs are administered by intravenous (IV) infusion at a clinic, which may add costs beyond prescription medicine copays. When you factor in administration costs at the clinic, time off work, and sometimes even travel costs to visit the infusion center, the price of MS treatment can become even steeper.

Read on to learn more about strategies that may help you save on your MS medications, the cost of infusion, and even infusion-related travel expenses.

How Do Infusion Costs Affect People With MS?

One small study of people on infused DMTs for MS found that average annual costs exceeded $70,000 for these medications and their administration fees. Insurance doesn’t always cover the entire amount, leaving those with MS left facing excessive bills.

Infusion costs are a common topic of concern on MyMSTeam. “Knowing how much MS medication costs, how are people without insurance able to pay for their medication?” one member wrote.

“I know how high the financial burden is when I have to go to get my infusions or just see the doctor,” another member said. “I need to travel to the Cleveland Clinic, and usually that entails staying overnight at a motel, plus the fuel costs are ridiculous. Then this cost rolls downhill to our personal finances.”

For people with MS who need help with out-of-pocket expenses such as copays and deductibles, copay assistance programs may be able to help cover some of the costs associated with MS infusion treatment.

What Is a Copay Assistance Program?

Copay assistance programs are for people with insurance who still have out-of-pocket expenses for medical treatments due to copays and high deductibles. These programs can help cover the costs of:

  • Prescription drugs
  • Copays
  • Deductibles
  • Medical insurance premiums
  • Coinsurance

Some programs have household income requirements, and you will qualify only if your income is below a certain limit.

Some copay programs are operated by organizations that distribute financial support for copays and other expenses related to a medical condition. These programs may provide direct payments to drug or health care providers. They also may provide reimbursement for payments already made.

Other programs, such as prescription drug savings cards, copay cards, and copay coupons, can provide immediate rebates for prescription drugs when you purchase them at a pharmacy. Prescription savings cards helped save Americans almost $200 million from 2009 through 2016 — an average of $18 per prescription. These programs are generally designed for people with commercial insurance, and they do not apply to people on Medicare or Medicaid.

Many drug companies also provide direct assistance to help reduce the cost of medication for those who qualify. These programs pay some or all of a person’s out-of-pocket expenses after their insurance company has paid its portion. With some insurance plans, these payments may count toward your annual deductible or maximum out-of-pocket payment limit.

How Copay Assistance Programs Can Help Pay for MS Infusion Drugs

Five infused DMTs have been approved by the U.S. Food and Drug Administration for treating MS. Each has a different schedule of infusions:

  • Alemtuzumab (Lemtrada) — Given over a course of five days, followed by another three-day round a year later
  • Natalizumab (Tysabri) — Administered every four weeks for relapsing forms of MS
  • Ocrelizumab (Ocrevus) — Infused every six months
  • Ublituximab-xiiy (Briumvi) — Administered once every 24 weeks
  • Mitoxantrone (Novantrone) — Given once every three months

Numerous savings programs are available to offset some of the costs associated with these drugs and the associated administration. Copay relief programs’ requirements and limitations differ, depending on which state you live in. You may want to ask a nurse or social worker at your neurologist’s office to help determine which program may be best for you.

“Got my meds, and a discount program is helping to cover the $2,500 copay,” one MyMSTeam member reported.

Ask your doctor or pharmacist about copay assistance programs and other forms of financial support that may be available for the drugs you need. They may be familiar with programs that offer support for MS drug expenses.

Organizations That Provide Assistance

Several nonprofit organizations have copay assistance foundations that provide support to people with MS. You can refer to the following organizations, among others, for more information on the status of their programs, eligibility criteria, and application process:

  • The Assistance Fund
  • HealthWell Foundation
  • Patient Advocate Foundation
  • Good Days
  • NORD

NeedyMeds, a nonprofit that connects people with resources to pay for medications, offers a free Patient Assistance Program Update Service with daily and weekly email reports on changes to programs, applications, and eligibility requirements.

Pharmaceutical Research and Manufacturers of America also provides detailed information and tools for accessing copay savings programs.

Copay Assistance From Drug Manufacturers

Drug manufacturers with copay assistance programs will have information on their websites. Copay assistance grants from drug manufacturers are typically limited to people with private (commercial) insurance. Visit the manufacturer website for a drug your doctor has prescribed, and look for menu options such as:

  • Copay assistance
  • Financial support
  • Insurance coverage
  • Manufacturer coupon
  • Savings card

You can also look at the Multiple Sclerosis Association of America’s database of prescription assistance programs operated by various DMT manufacturers. Don’t hesitate to call these companies to inquire about copay assistance. One of their representatives can talk with you about the programs they offer, eligibility requirements, and how to apply. The doctor who prescribed your medications may need to provide them with information about your prescription.

“If any of you are having trouble with copays, please contact the manufacturer of your particular medication,” wrote a MyMSTeam member. “I did, and I’m getting $9,000 a year toward my copay.”

“After copay assistance went through, my Ocrevus bill was only $5,” another member wrote. “I’m floored and feel like crying with relief and happiness.”

Can You Get Copay Assistance if You Have Medicare or Medicaid?

People with Medicare Part D, which offers prescription drug coverage, may qualify for copay assistance if they meet certain requirements.

If you would like more information about Medicare Part D drugs and prescription coverage, call 800-633-4227 or search for your state insurance department. If you are eligible for both Medicare and Medicaid, you may have more options.

Copay Accumulator Programs

Some private health insurance plans may have a copay accumulator program. With these programs, the amount paid by a drug manufacturer will not count toward your deductible and out-of-pocket maximum under your health plan.

If your health plan has a copay accumulator program, you may still owe a significant amount of money toward your deductible after reaching the maximum annual amount offered by your copay assistance program.

Ask your insurance provider or your employer’s human resources administrator if your health plan includes a copay accumulator program. If so, be sure to talk to your employer if you need help paying for drugs due to high costs.

Copay accumulator programs are controversial. Several states have passed or introduced legislation to ban or restrict them.

Help With Nonprescription Costs

Because DMT infusions may involve expenses beyond copays, you may also want to explore other programs that can help with financial assistance for those out-of-pocket costs.

The Multiple Sclerosis Foundation offers grants for transportation assistance, which helps people with MS get to medical appointments, and emergency assistance to help pay for rent or other utilities. You might consider applying for programs like these to offset costs that you incur while getting your infusions.

Talk With Others Who Understand

On MyMSTeam, the social network for people with multiple sclerosis and their loved ones, more than 197,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Do you participate in a copay assistance program or receive another form of financial assistance with your infused DMT? Do you have advice for others looking to reduce drug-related expenses? Share your thoughts and experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on April 14, 2023
    All updates must be accompanied by text or a picture.

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    Torrey Kim is a freelance writer with MyHealthTeam. Learn more about her here

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