According to the Alzheimer’s Association, more than 5 million Americans are living with Alzheimer’s Disease right now. It is the 6th leading cause of death, killing more people than breast cancer and prostate cancer combined. When you know the facts about Alzheimer’s disease or you’ve seen a loved one suffer from it, you know that it is a scary diagnosis.
While there is currently no cure for Alzheimer’s or any method of halting its progression, there are medications that can ease some of the symptoms. One such drug is Namenda.
Namenda is used to treat moderate to severe Alzheimer’s. When taken correctly, it might improve memory, awareness, and the ability to perform daily activities. It works by decreasing abnormal activity in the brain.
It can be a huge relief to both the patient and their family to find any kind of treatment that works but it can be incredibly defeating to see how expensive the medication can be. Namenda prices vary across the country but it can cost between $260 and $413 a month.
When people cannot afford the drugs that their doctors prescribe they might decide not to take them or to make a sacrifice in another part of their life to afford their medicine. Luckily, many pharmaceutical companies offer patient assistance programs to help low income families and under-insured families get the medicine they need for free. If you or a loved one takes Namenda (or one of the many Allergan medications on the program) you might qualify for free medication.
HOW TO QUALIFY
To qualify for the Allergan patient assistance program, your household income can be up to 4 times the federal poverty level (https://aspe.hhs.gov/poverty-guidelines).
You have to prove your income by sending in financial documents, like the most recent year’s tax forms. If you don’t have the most recent year’s tax forms, you can also use:
award letters for Social Security, Workers Compensation, unemployment, etc
monthly benefits statements
bank statements from the last 60 days, with source of income clearly indicated
2 consecutive pay stubs, must show the gross amount
If you don’t have any income, your doctor must write a letter on their office letterhead stating that, to the best of their knowledge, you have no income.
It is possible to qualify for the Allergan patient assistance program even with insurance. The patient assistance program will do a benefits investigation based on the insurance information that you provide on the application.
If Namenda (or another drug on the Allergan patient assistance program) is not covered by your insurance for some reason, you only need to write on the insurance portion of the application: “(med name) is not covered” and the reason why (coverage exhausted, med class not covered, etc). No additional documentation will be necessary. If the medication is covered but the copay is too high, you must make note of your copay amount on the Allergan application.
You can find the application for the Allergan patient assistance program, along with detailed instructions, on the Allegan website. Their instructions don’t cover every possibility so you will have to call the program and talk to their customer service representatives if you get stuck. You can reach them at 844-424-6727. It’s better to ask questions in the beginning than to send in the wrong information and get denied.
Be sure that you and your doctor fill out the application as neatly as possible. If you make any errors, you can either print out a new application or you can use white-out. When the application is complete and you have gathered your financial documents, you can either fax or mail the information to Allergan.
Faxed applications must be sent from your doctor’s office and must have a cover sheet with your doctor’s letterhead/fax banner on it.
If you mail in your application, be sure to only send copies of your financial documents to the program. It’s good to keep the originals because you will not get any of your documents back from Allergan once you have sent them in. That way, if you need to reference them or resend them for any reason, you will still have them.
Allergan Patient Assistance Program
PO BOX 66764
St. Louis, MO 63166
MEDICATION AND REFILLS
All medication from the Allergan Patient Assistance Program must be sent to your doctor’s office. If your doctor’s office refuses to receive and dispense your medication, you can check with your pharmacy to see if they will agree to receive it instead. If they will, ask the pharmacy to write a letter to the Allergan patient assistance program stating that they will receive your medication and then dispense it to you at no cost.
Remember that it takes about 4 weeks for the Allergan Patient Assistance Program to process your paperwork. It’s not a quick solution, unfortunately. On the other hand, once you get into the program (if your doctor remembers to order refills on time) the medication will come regularly.
About 75 days after your first shipment (and every 75 days after that) your doctor needs to order a refill. They can do this by using the automated phone system (1-844-424-6727) or by sending in a prescription by fax.
Your enrollment in the Allergan patient assistance program will last 12 months. About 4 weeks before your enrollment ends, if you still need help, you can re-enroll in the program. You will just need to check with Allergan to make sure that they still have a program and that their application and the rules haven’t changed.
MEDICARE PART D
If you have Medicare Part D, your experience will be a little different. First of all, your enrollment will only last until the end of the calendar year, not for a full 12 months.
Also, if you have Medicare Part D you have to provide Allergan patient assistance program with a copy of a Low Income Subsidy denial letter. You cannot be enrolled in the Allergan patient assistance program with Low Income Subsidy so you must provide proof that you aren’t receiving the extra help.
The Low Income Subsidy program is also called the Extra Help program. It is a program offered by the Social Security Administration that provides extra help with prescription medications. You can find it here: https://www.ssa.gov/medicare/prescriptionhelp/
You will need to apply for the program. If you get into it, they should help you with your medication. If they deny your application, you will get a denial letter that you can send it in to Allergan to get into their patient assistance program.
WHAT IF YOU GET DENIED?
If Allergan does deny your application, there is still a chance that you will be accepted into the program if you go through an appeals process.
Allergan will allow appeals if they denied you for being over the income guideline but
your income has changed.
your medical costs, prescription costs, and living expenses are too high.
IF YOUR INCOME HAS CHANGED
In this case, you will need to send your original proof of income and then proof that your income has changed since you sent in the original paperwork.
IF YOUR INCOME IS TOO HIGH
In this scenario, you can appeal the denial by sending in several additional documents. You will need to write a letter in which you describe the income of everyone in your household and also the living expenses, prescription costs, and medical costs. Allergan wants to see your budget and where the money goes. Then you will need to send in printouts and receipts proving your expenses.
Pharmacies can easily give you a printout of your prescription costs. You might have to get receipts from your doctor office(s). To prove your household expenses, you can use copies of bills. Remember, you will need this information for any person living in your household.
FOR EITHER APPEAL
In either case, you will have to submit your appeal within 90 days after being denied. If you don’t appeal your denial, you will have to wait 90 days to reapply.
Allergan patient assistance program also requires that your doctor write you a letter of medical necessity. That just means your doctor writes that they prescribed the medication to treat the health issue that they diagnosed and that, in their opinion, it’s necessary to your health that you continue to take that medication.
Appeal paperwork can be faxed directly to Allergan Patient Assistance Program 844-872-5462 from your doctor’s office, with their fax coversheet.
The Allergan patient assistance program is pretty straight-forward and they do have customer service representatives available to answer questions about their program or their application during normal business hours. Appeals are more work but the medication is free so it’s definitely worth it.
If you need help getting enrolled in the Allergan Patient Assistance Program, Prescription Lifeline can assist you! Contact Prescription Lifeline at www.PrescriptionLifeline.org or call and speak to a patient advocate at 1-888-331-1002. Whether you need help with prescriptions or you’re just curious about getting the best price for your Medicare coverage, Prescription Lifeline is here to help.