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Making sense of financial support programs.

We know that pulmonary arterial hypertension (PAH) treatment is expensive. Costs add up and may be more than you can afford. At CVS Specialty®, we’re dedicated to helping patients with PAH in many of the ways that matter to you. This includes sharing information about financial help. 

It’s the time of the year to look carefully at your insurance coverage and your out-of-pocket (OOP) costs, like copays* and deductibles. Think about what you may need. Check out other resources like community groups, national organizations and drug company programs. Here are some ideas to help you learn about your financial resources:

  • First, organize the paperwork you need to show. This may include your yearly income, your medications and what your insurance covers.
  • If you’re already getting financial help, check to see if the same resource can help you again. Sometimes programs change. So, this is another way to find out what your options are.
  • Sign up for FundFinder. FundFinder is a no-cost tool that keeps track of many programs that offer financial help. It lets you know by email or text when a charitable copay assistance program (CPA) is available.
  • Sign up for newsletters to stay updated about what’s new. Other organizations may have information about financial help, or even provide it themselves. Consider organizations like:
  • Join a support group. You can connect with others living with PAH. They may have other ideas or know of resources that helped them.
  • Apply for foundation grants as soon as you can. Keep in mind that they’re usually accepted on a first come, first served basis.
  • Look into drug company patient assistance programs (PAPs).

Make the most of PAPs

Some drug companies have programs that may help cover part or all your copays. You can find the name of the drug company on your medication’s package. Go to that company’s website to see if they have a PAP and how to apply. You may need information about your insurance, how much money you make and your medications. The drug company will let you know if you qualify. If you do, they’ll likely send you a copay card that you can use to pay for your medication. Sometimes there is a limit to how much they cover. PAP information is not shared with your pharmacy. Be sure to send any PAP information to your pharmacy. This helps the pharmacy applied any financial savings to your prescription.

You can find contact information for PAH therapy companies at Pulmonary Hypertension Association (PHA). 

Questions to ask your insurance company

Insurance companies vary in how they deal with copay cards and PAP. Some insurance companies count the copay toward your deductible or OOP maximum. In these cases, your deductible and OOP costs will be less. Other insurance companies have what is called a copay accumulator program. They don’t count the copay card or PAP towards your deductible or OOP. In those cases, you are still responsible for paying the entire deductible and OOP amounts per your insurance policy. It’s important to know how your insurance policy deals with PAP and copay cards.

Here are some questions you can ask your insurance company or Human Resources representative.

  • How much is my deductible for the year?
  • Do I have more than one deductible? Some insurances have a separate deductible for medical costs and medication costs
  • What is my OOP for the year?
  • If I have a PAP or copay card, does it count towards my deductible or OOP maximum? (You’re asking if they have a copay accumulator program)
  • Is there a copay a PAP can cover? (The PAP may have a limit, too, but that is a question for the drug company)
  • Find the best plan for you. Start by visiting PHA for insurance benefits counseling.

Living with PAH is challenging. You’re not alone on your often-confusing financial journey. We’re here to help. Ask your CareTeam about PAP and copay card programs. Let them know about any financial help needs you may have.

Your CVS Specialty CareTeam can help you stay on track with your medications, answer your questions and connect you with resources. Call your CareTeam 24/7 at 1-87-PAHCARE-8 (1-877-242-2738).

Connect with trusted partners and organizations that can support your journey. 

Learn more

*Copayment, copay or coinsurance means the amount a plan member is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan.

This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about your medical condition and prior to starting any new treatment. CVS Specialty assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result. 

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