Patient Assistance Programs and Co-Pay Programs for PEP

There are two types of programs that help people access their prescription drugs for post-exposure prophylaxis (PEP). PEP is when a person takes a 30-day course of antiretroviral drugs within 72 hours of being exposed to HIV. One of the programs, sometimes known as a medication assistance program (MAP) and other times as a patient assistance program (PAP), provides free drug to those without health insurance or prescription drug coverage. The other, a drug co-pay program, provides assistance with out-of-pocket costs (including co-pays, co-insurance and deductibles) for people who have insurance.

PAPs and Copays for PrEP may have limits on the amount of money a person may earn each year to qualify for the program. This income limit is not a fixed amount. Instead it is based on the federal poverty level (FPL) for a given household. People with more people in the household may have higher household incomes than people with fewer people in the household. For instance, people with a single person in their household may earn up to approximately $58,000 per year if the income limit is 500% of the FPL.

Eligibility qualifications and drug access varies a great deal from company to company (and from non-profit foundation to foundation), and accessing a full combination (which usually means getting drugs from different companies with different requirements and processes) may be challenging. Given that people are often provided with only two or three days of medication after seeing a provider, and must urgently obtain the rest of their medications, getting drugs on time is even more difficult.

The drugs listed below are those most commonly used for PEP in the United States. It is possible that your provider may prescribe a drug not included here. Please click here for a list of additional companies and drugs and the contact information for their PAPs for HIV treatment.

Patient Assistance Programs (PAPs)

Abbvie – Norvir and Kaletra
Phone: (800) 222-6885
Hours: M – F, 8:00 a.m. to 5:00 p.m. Central Time
Website: www.abbviepaf.org

Eligibility:

  • No income requirements or insurance requirements.
  • Covers Medicare, but not Medicaid
  • No citizenship requirements. Must be residents in the United States and territories

Process:

  • Patient and provider must fill out the application found on the website listed above and fax to (866) 483-1305
  • Medication is shipped within 48 hours to provider’s office.

Bristol-Myers Squibb – Reyataz and Evotaz
Phone: 888-281-8981
Hours: – M – F, 8:00 a.m. to 8:00 p.m. Eastern Time
Website: www.bms.com/documents/products/access_virology_application.pdf

Eligibility:

  • Applicant must have no health insurance or insurance with no prescription drug coverage.
  • People with Medicaid are not eligible. People with Medicare may be elligible, with restrictions
  • Income must be below 500% FPL.
  • Must provide proof of income (e.g. tax documents or pay stubs)
  • No citizenship requirements. Must be residents in the United States and territories

Process:

  • Patient and provider must fill out the application found on the website listed above and fax it to (888) 281-8985
  • PEP gets expedited review and processing, but from application submission to drug delivery may be 3 to 4 days.
  • Drug ships to provider’s office or patient’s home.

Gilead – Truvada, Tybost and Stribild
Phone: 800-226-2056
Hours: M – F, 9:00 a.m. to 8:00 p.m. Eastern Time
Website: http://services.gileadhiv.com/content/pdf/gilead_enrollment_form.pdf

Eligibility:

  • Applicant must have no health insurance. The program will also cover those with insurance who have had coverage of the medication denied or who have no prescription drug coverage.
  • Applicants with Medicaid or Medicare are not eligible.
  • Income must be below 500% of FPL
  • No citizenship requirements. Must be residents in the United States and territories. Program asks for social security number, household income and household size. No proof of income required.

Process:

  • For PEP, provider must fax a letter of medical necessity, that includes the patient name, date of birth, purpose of request, drugs requested, and date of exposure – Fax to 800-216-6857
  • Only offers one expedited voucher per lifetime. Second vouchers may be provided, but process is not expedited.
  • Have doctor fax letter, wait 20 minutes and then call to finish process, will be given a voucher number for the pharmacy.

Janssen – Prezista and Prezcobix
Phone: 800-652-6227
Hours: M – F, 9:00 a.m. to 6:00 p.m. Eastern Time
Website: www.jjpaf.org
Fax: 888-526-5168

Eligibility:

  • Income below 200% FPL.
  • For PEP there is no income verification requirement, but must check “No” on the form for filing taxes.
  • Applicant must not have health insurance or insurance with no drug coverage.
  • Participant must not be eligible for Medicaid, but the PAP does cover some people with Medicare.
  • No citizenship requirements. Must be residents in the United States and territories. Must be prescribed treatment by a U.S. provider.

Process:

  • An application must be filled out by the provider and patient. Must ask for expedited review and handling.
  • Drugs can be shipped to provider’s office, or a voucher number can be given over the phone and taken to a pharmacy.

Merck – Isentress
Phone: 800-850-3430
Hours: M – F, 9:00 a.m. to 6:00 p.m. Eastern Time
Website: www.merckhelps.com/Programs.aspx
Fax: 866-410-1913

Eligibility:

  • No insurance or income criteria.
  • Applicants with Medicaid and Medicare are not eligible.
  • No citizenship requirements. Applicant must be a resident of the United States or territories, and must have a prescription from a U.S. provider.

Process:

  • Patient and provider complete application and fax it in.
  • Call back 20 minutes later for completion. If completed M – Th by 11:30 a.m., drugs are shipped overnight to provider’s office or patient’s home. If after 11:30 or on a Friday there may be a delay.
  • Though no income or insurance requirements, patient must complete the sections on household size and insurance and sign and date applications on both pages.

ViiV Healthcare – Combivir, Tivicay
Phone: 877-784-4842
Hours: M – F, 9:00 a.m. to 7:00 p.m., Eastern Time
Website: www.viivhealthcareforyou.com
Fax: 877-784-4004

Eligibility:

  • Applicant must have no health insurance or no drug benefit with private insurance.
  • Applicant must not be eligible for Medicaid. They may have Medicare, but PAP coverage may vary.
  • Requires proof of income, see website for details.
  • No citizenship requirement. Covers U.S. and Puerto Rican residents, but not other U.S. territories.

Process:

  • For PEP, expedited enrollment can occur if handled by a registered advocate at the provider’s office or pharmacy. Once the application form is completed and signed by the patient, a voucher for 30 days of medication will be provided that is redeemable at most major pharmacies.

 

Co-Pay Programs for PEP

Abbvie – Norvir and Kaletra
Same as PAP – free drug shipped.

Bristol-Myers Squibb – Reyataz and Evotaz
Phone: 888-281-8981
Hours: M – F, 8:00 a.m. to 8:00 p.m., Eastern Time
Website: bms3assist.com/copay
Amount: $6,800 per year – no monthly limit – covers deductibles

  • Offers assistance to those with a valid prescription and who have private commercial insurance. People with Medicaid and Medicare Part D are not eligible.
  • Patient (or provider or pharmacy with patient’s consent) can call to get a co-pay card number to cover the cost of the prescription.
  • For those who have pharmacies that do not accept the card, keep your receipt and call McKesson Corporation at 877-505-6987 within 30 days of purchase to request a Direct Member Reimbursement (DMR) form.

Gilead – Truvada, Tybost and Stribild
Phone: 877-505-6986
Hours: M – F, 9:00 a.m. to 8:00 p.m., Eastern Time
Website: www.GileadCoPay.com
Amount: The amount of discount varies by drug. For Truvada it is $300 for a 30-day supply and for Tybost it is $50 for a 30-day supply. Gilead does not cover deductibles for those two drugs. For Stribild, Gilead covers up to $6,000 per year.

  • Offers assistance to those with a valid prescription and who have private commercial insurance. People with Medicaid and Medicare Part D are not eligible.
  • People may apply online and print out a card to take to the pharmacy or call the number above.
  • For those who have pharmacies that do not accept the card, keep your receipt and call McKesson Corporation at 877-505-6987 within 30 days of purchase to request a Direct Member Reimbursement (DMR) form.

Janssen – Prezista and Prezcobix
Phone: 866-961-7169
Hours: M – F, 8:00 am to 6:00 pm – Saturday 8:30 to 2:00 pm
Website: www.prezista.com or www.prezcobix.com
Amount: $7,500

  • Go to the website, print savings card and call to activate and use it at a pharmacy.
  • If the pharmacy does not accept copay cards, reimbursement can be sought by going to www.opushealth.com. Download rebate form fax in with required documents.

Merck – Isentress
Website: www.activatethecard.com/6919/#
Amount: $400 per month

  • Must apply online and download card.
  • People with private insurance are eligible, not those with Medicaid or Medicare.
  • Does not cover deductibles.
  • Go to website to activate and download a card, present at the pharmacy with a valid prescription. If your pharmacy doesn’t take the card, keep your receipt and call McKesson Corporation at 877-505-6987 within 30 days of purchase to request a Direct Member Reimbursement (DMR) form.

ViiV Healthcare – Tivicay
Phone: 877-844-8872
Hours: M – F, 8:30 a.m. to 5:30 p.m., Eastern Time
Website: www.mysupportcard.com
Amount: $6,000 per year

  • Applicants must have private health insurance.
  • Applicants with Medicaid or Medicare are not eligible.
  • To obtain a card, simply visit the website, complete the application and download the card.