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A myPHteam Member asked a question 💭
Franklinton, LA
January 21, 2024
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5 Tips for Affording PAH Medication: Assistance Programs, Specialty Pharmacies, and More Read Article...

Answer Summary

Members rallied around someone facing overwhelming costs for Opsumit ($13,600 for 30 days), sharing detailed strategies for financial... Read more

Members rallied around someone facing overwhelming costs for Opsumit ($13,600 for 30 days), sharing detailed strategies for financial assistance including PAN Foundation grants, HealthWell Foundation support (which reopened with $10,000 annual grants in February), the Assistance Fund, Pulmonary Hypertension Association Patient Advocate Foundation, and direct manufacturer assistance programs through Janssen. Several members explained Medicare Part D's catastrophic phase, where after spending $3,250 on co-pays, medications become free for the rest of the year, and many shared their personal success stories of receiving grants or zero co-pays through combinations of Medicare, pharmaceutical assistance, and foundation support. A recurring theme was the critical importance of persistence in applying for multiple funding sources simultaneously, keeping track of foundation enrollment windows which close quickly, and advocating firmly with doctor's offices and specialty pharmacies when the system creates delays or confusion.

A myPHteam Member

I am on Wellcare plan D through Medicare. They list PH meds that are approved and covered with minimal to no cost. Opsumit is made in Switzerland. Wellcare approved Opsumit but I still owe $3000.00. I was approved for the PAN grant. Hopefully they will cover what I owe . Wellcare paid $7000. I’m also on Tyvaso. PAN grant was approved for this one too. It is worth time and effort to apply for the grant. It is an easy process and you find out immediately if you are approved.. Hope this is helpful to y’all. God bless.

January 21, 2024
A myPHteam Member

Michael: The PAN application is very easy on-line and no paperwork was required. The $3250 was instantly awarded. And if you are on Medicare D or C, getting into the Catastrophic phase is automatic. You don't need to file anything. If you are not comfortable navigating around websites, maybe your daughter can do the PAN application for you. I believe there is a line in the app that lets you indicate if you are applying on somebody else's behalf.

January 21, 2024 (edited)
A myPHteam Member

Jackie: It might be time to get your senator's office involved. I don't know if it would be their Medicare liaison you would want or just a general community liaison, but you should be able to start the process on their website. Ten years ago I had been given the runaround from Social Security. My then Senator had numerous staff members whose sole functions were to help constituents out with dealing with bureaucracy. They took care of my issue in 3 weeks with my having just 2 phone calls with them and a handful of emails.

January 23, 2024 (edited)
A myPHteam Member

I get my help from the Assistance Fund. You can also call who you get your medicine from. My doctor's office also helps.

January 21, 2024
A myPHteam Member

Well, you could still see if your daughter can file for the PAN money on your behalf. If you are on the phone with her while she fills out the on-line questions, it should go quickly enough. Either way, best of luck to you.

January 21, 2024

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