How Will I Afford My PAH Medications?

pulmonary hypertension medicationsThe cost of Pulmonary Arterial Hypertension medications is staggering.  The least expensive medication  (generic sildenafil) costs $50 per month for 90 tablets.  If you prefer to have the branded version and you don’t have any insurance expect to pay more than $3,000 per month.  Insurance companies are very happy to pay for generic sildenafil but increasingly restrict Adcirca (Tadalafil) to patients that are also being treated with Letairis (Ambrisentan).  Adcirca costs about $3,000 per month without insurance.

Now that we have covered the inexpensive medications let’s talk about the more expensive ones.  The endothelin receptor antagonist (ERA) category which includes Letairis (Ambrisentan) and Opsumit (Macitentan) cost about 2.5 times what Adcirca costs.  The prostanoid family of medications includes Remodulin (Treprostinil), Tyvaso (inhaled Treprostinil), Orenitram (oral Treprostinil), Flolan/Veletri (Epoprostenol) and Uptravi (Selexipag).  The retail cost of these medications approaches or exceeds $200,000 per year.  Orenitram can cost close to $800,000 per year if you are on a high dose.   Keep in mind that your insurance company does not pay retail to acquire these drugs.  It is obvious that few people on the planet can afford these drugs.  Even 20% co-insurance (your payment is 20% of the full cost) is prohibitively expensive for more than 99% of Americans.

Drug companies have found a variety of solutions to help patients afford their medications.

  1. Copay assistance programs
  2. Foundation support from Caring Voices Coalition
  3. Free medication for patients that have been denied coverage by their insurance or patients that are ineligible for insurance coverage

Copay Assistance for Patients with PAH

Copay assistance is a support program available to patients with commercial insurance coverage.  Each branded drug manufacturer in the PAH arena will directly pay to the specialty pharmacy or regular pharmacy up to about $9,000 per year towards the patient’s portion of their drug cost.  If your portion of the costs exceeds $9,000 then you will need to find another form of support to cover that part (see below).

Foundation Support: Caring Voices Coalition

The primary charitable foundation that is involved in PAH is Caring Voices Coalition.  This charity receives money from drug manufacturers and then provides charitable grants to patients that qualify (have income less than 450% of the poverty level, have prescription insurance coverage, be a legal U.S. resident and not receive assistance from another organization).  Due to increased scrutiny, patients are required to re-qualify every year.

Free Medications for Pulmonary Hypertension

If you have been denied health insurance or your health insurance refuses to cover a PAH medication, most of the manufacturers have programs to provide the medication free of charge to the patient.

What if I don’t qualify for help?

This scenario is most commonly encountered with Medicare patients as they are not eligible for Copay Assistance programs.  If your income is 451% of the poverty level  (or higher) then you will not be eligible for Caring Voices support.  This can happen if you take a distribution from your retirement account or if your investments did better than previous years and your income increases.  Many patients across the country are now in the very precarious position of losing their foundation support.  This would expose them to having to pay for tens of thousands of dollars in medication costs per year.  PAH specialists from around the country are encountering patients with this very problem.  The Pulmonary Hypertension Association is aware of this problem.  However, an easy solution is not yet apparent.

What can you do?  Write your congressional representative or senator.  Write letters to your local newspaper.  Make noise.  The more attention this issue gets the better the chance that a solution will be found.  Work closely with your PAH physician.  Speak openly about any barriers to getting your medications.

Stay tuned for more information on this topic.