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Treatments for rheumatoid arthritis (RA) such as biologics can be very effective, but they can also present a financial burden. Certain biologic medications can cost up to $6,000 per year in out-of-pocket expenses — even with insurance coverage. Although the cost of biologics and other antirheumatic treatments may create a barrier to their use, many private and public programs can help reduce the cost of RA treatments.
Members of myRAteam, the online support network for people with RA, discuss the stress of affording RA medications. One member commented, “It may be time for me to consider biologics. My biggest concern is, how on earth am I supposed to pay for them?”
A common form of financial assistance for RA drugs is through copayment, or copay, assistance. A copay is the amount of money a person owes for a drug after insurance. Copay assistance is offered by drug manufacturers, nonprofit organizations, and the government. Your eligibility may depend on whether you have insurance, if you have a public (Medicare or Medicaid) or private insurance plan, and your income.
Overall, copay assistance aims to help people with RA afford costly medications. You'll find information about several types of copay assistance programs below, including information about how you can check your eligibility and apply for different programs.
Prescription assistance programs (PAPs) are one type of financial support for prescription medications. These programs are offered directly by pharmaceutical companies to help people who need assistance paying for their prescription medications.
There are more than 375 PAPs in the United States, and every year, they provide $13 billion worth of various medications to people who have trouble affording them. Oftentimes, doctors and even pharmacists won’t know about these programs, so you must research them to see if you qualify for assistance.
PAPs may cover either brand-name or generic medications. Sometimes, certain medications or specific doses of that medication will be offered through a PAP but then not offered at other times. Check the PAP’s website for the most up-to-date information.
Different medications for RA have PAPs. Some include:
To explore additional PAPs and other financial assistance options, visit the brand website for the RA drug you’ve been prescribed. GoodRx.com, an in-real-time prescription price search website, publishes a large collection of drug PAPs, so be sure to look there for your prescribed medicine.
Because PAPs are offered by drug manufacturers, qualifications to receive assistance depend on the drug. As a baseline, PAPs typically require that you are uninsured and that your household income is at or below the federal poverty level.
Eligibility criteria for each PAP are different, so you need to review the criteria for your specific medications to check if you are eligible. You can review PAPs for different RA drugs directly at the manufacturers’ PAPs’ websites.
One way to find PAP websites is through Google, by searching the name of the drug plus “PAP” or “prescription assistance program.” You can also explore the list of PAPs for RA drugs through the search function on NeedyMeds.org.
The application for each PAP is different. You’ll need to provide some amount of personal and financial information on your application, which will vary based on the PAPs you’re applying for.
All PAP applications require a doctor’s signature. Some programs may also require that your doctor fill out a portion of the application.
If your application for a PAP is accepted, the program will send the medication directly to your home, to your doctor’s office, or to the pharmacy. Because RA drugs are usually taken over a long period of time, PAPs for RA drugs (and medications for other chronic diseases) may offer refills. The PAP will cover most or all of the costs of the medication.
Copay savings cards are another form of financial assistance issued directly by drug manufacturers. These copay cards work like a coupon for prescription drugs. However, these savings programs are usually only for brand-name drugs and are usually only for eligible patients who are enrolled in a private health insurance plan (not Medicaid or Medicare).
Some examples of copay savings programs for RA drugs include:
You may browse copay savings cards for other drugs by doing a Google search of the prescription medicine name you’re taking plus the term “copay savings card.”
There are also several different copay assistance programs offered through nonprofit organizations. These programs have different eligibility requirements and provide different types of financial help, whether it’s assistance for copays, deductibles, co-insurance, or other aspects of managing a chronic condition.
Review the eligibility information on each program’s website to check if you qualify for support. Some examples of programs that offer copay assistance for RA drugs are described below.
NeedyMeds is a nonprofit organization that serves as a search tool for different drugs and drug savings programs and it also offers a Drug Discount Card that helps with the cost of medications. Visit their website and use the search tool to explore assistance options for the RA drugs you’ve been prescribed.
Benefits CheckUp is a resource created by the National Council on Aging that connects people with different benefits, including copay assistance for prescription drugs. Visit the Benefits CheckUp website, and use the search tool to find copay assistance or other assistance programs you may be eligible for.
Other organizations such as The Assistance Fund, The Patient Advocate Foundation, and The Patient Access Network (PAN) Foundation provide financial help for antirheumatic drugs, but they are currently full or are no longer providing funding. Sign up for the waitlist or check back in with these programs on their websites to see if additional funding opens up in the future.
Several state and federal programs can help cover the cost of prescription drug copays. If you are uninsured, review your eligibility for public health insurance programs like Medicare, which covers people who are at least 65 years of age or receive Social Security disability benefits. Medicare Part D covers pharmaceuticals and offers different savings and rebate programs.
Medicaid is the state-based insurance program that provides insurance for individuals with a low income. You can also explore private programs like individual insurance plans through the health insurance marketplace.
State pharmaceutical assistance programs offer financial assistance for different medical conditions based on where you live. Explore programs offered by your state using the search tool at this link.
Your health care professional or rheumatologist could be a helpful resource for copay assistance for your RA drugs. If you are having trouble affording a prescribed medication, tell your doctor. They may be able to prescribe you similarly effective, less expensive drugs. They may also know about additional resources that can help you save money.
Another great resource is talking to your peers with RA. Perhaps one or several of your peers on myRAteam have used PAPs, copay cards, or other resources, and can help you navigate the process. Members of myRAteam ask about using PAPs to help cover the cost of their RA drugs.
“Does anyone have experience with the financial assistance/foundation programs to help with the cost of RA? I was wondering how others have handled the waiting period and other times when finances are hard.” Posting a general question or comment through the Activities page may garner some helpful information from people who understand what you are going through.
On myRAteam, the social network for people with rheumatoid arthritis, more than 171,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.
Do you have RA and use copay assistance? Share your experience in the comments below, or start a conversation by posting on your Activities page.
Ariel D. Teitel, M.D., M.B.A.
is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network.
Learn more about him here.
Elizabeth Wartella, M.P.H.
is an Editor at MyHealthTeam. She holds a Master's in Public Health from Columbia University and is passionate about spreading accurate, evidence-based health information.
Learn more about her here.
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Very good information.
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