CMLSupport: Gleevec And Insurance

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Gleevec And Your Insurance Coverage

Your Help Is Needed:
How would you feel if you knew Glivec could help you but you couldn't afford to pay for it? That's exactly what could happen to scores of Medicare patients. Dr. Brian Druker is asking for our help.Click here to help.

Gleevec Hotline: (877) GLEEVEC

Insurance and Payment Concerns

The U.S. Food and Drug Administration approved marketing of Gleevec (Glivec/STI) in the United States on May 10, 2001. What does that mean? How can you get it? Will your insurance company cover it? What if you don't have insurance at all?

Your doctor will now be able to prescribe Gleevec for treatment of your CML (and other types of cancer, such as GIST and brain tumors).

If you had to pay for Gleevec out of your own pocket, it would cost about $2,000 to $2,500 a month, or about $30,000 annually.

You should be able to get Gleevec from pharmacies by Friday, May 18, 2001

Your insurance company will probably cover Gleevec. However, you might have to file an official appeal with your insurer for coverage. Find out what your insurer's prescription policy is and how long it takes to add new FDA-approved drugs to its formulary or tier system. If you have trouble, contact your state insurance department or Novartis.

For free help from Novartis, the drug's manufacturer, call (877) GLEEVEC.

According to information provided to CMLSupport by Novartis, the drug company has initiated an income-sensitive payment program to help patients pay for Gleevec. You must call the Reimbursement Hotline toll-free at (877) GLEEVEC to kick off the payment assistance program.

The hotline will review your insurance or Medicare information with you and then attempt to find an outside funding source, if you qualify, through a nonprofit or consumer group. You'll be informed what your copayment for the drug is.

If an outside funding source is not found, you'll be referred to the Gleevec assistance program, which has income-sensitive guidelines in place.

Patients on Medicare who do not have a prescription drug program will not have to pay for Gleevec if their income is below $43,000 annually. If your income is over $43,000, you will pay for Gleevec on a graduated scale. Assistance is capped if your income (for a single-person household) is over $100,000. There have been some reports that patients are not being given the correct information by Novartis phone representatives. Novartis is aware of the problem and working to correct it.

You will also be eligible for the Patient Assistance Program if you don't have any insurance at all, including Medicare. The same income guidelines apply, with Gleevec being available for free if your income is less than $43,000.

If you have private insurance: "The private insurance companies have all reacted quite positively to covering Gleevec, so there shouldn't be any problem there," said Novartis spokeswoman Gloria Stone. You must check with your insurer about your coverage. The Gleevec hotline reps will help you sort out your insurance issues.

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