Paying for VELCADE
When you or your healthcare provider call the VELCADE Reimbursement Assistance Program (VRAP), one of our dedicated Case Managers will be available to answer questions and provide helpful information. VRAP is available 8:00 am to 8:00 pm EST, Monday through Friday. Call 1-866-VELCADE (835-2233), option 2.
- Dedicated Case Managers are available
- Calls are accepted from patients, caregivers, physicians, and other healthcare practice professionals
- Information can be mailed or faxed to patient or caregiver’s home or physician office
VRAP provides the following services:
- Insurance verification
- Payer policy research
- Claim appeals support
- Identification of alternative and supplemental insurance coverage options
- Co-payment Foundation support information
-
Screening and enrollment of eligible patients into the Patient Assistance Program
- If you have no insurance coverage for VELCADE, you may be eligible to participate in the Patient Assistance Program. If you qualify for the program, free VELCADE product will be delivered to your treating physician
- Transportation resources
Common questions that patients ask our dedicated Case Managers:
- Will my insurance cover treatment with VELCADE?
- If I don’t have insurance, can anything be done to help me get my treatment with VELCADE?
- What will my out-of-pocket payments be for my treatment?
- If I am having difficulty paying my out-of-pocket costs, are there options that can help me?
- My insurance plan denied a claim for VELCADE – can you help me?
- Are there organizations that can provide more information on helping with financial challenges?
Medicare
The following section provides an overview of Medicare coverage, which includes: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage or Medicare Managed Care), and Part D (Prescription Drug Coverage).
Each of these parts will describe the different components of Medicare and the costs associated with each of them.
Part A - Hospital Insurance
Medicare Part A is also known as hospital insurance. It helps cover inpatient care in hospitals, including critical access hospitals and skilled nursing facilities. It also helps cover hospice care and some home health care, but certain conditions must be met in order to get these benefits.
You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working. However, if you aren’t eligible for premium-free Part A, you may be able to buy Part A if you meet the citizenship or residency requirements and the age requirements. There is a payment obligation once you are admitted to a hospital or a skilled nursing facility.
You can obtain additional information on Medicare Part A by going to
www.Medicare.gov.
Part B - Medical Insurance
Medicare Part B (Medical Insurance) helps cover services provided by a doctor and outpatient care. It also covers some other medical services that are not covered under Part A such as physical and occupational therapy, home health care, and some preventative services. Infused drugs like VELCADE are also covered under the Part B benefit. These services and supplies must be considered
medically necessary in order to be covered under Part B.
There are costs associated with having Part B Medicare. The monthly premium is automatically deducted from your Social Security check every month. If you don’t receive Social Security benefits, you will be billed for Part B. There is also an annual
deductible of $162 that you must pay before Medicare begins to pay its share. Typically you will have a 20%
co-insurance amount for services received under Part B. If you have a supplemental insurance plan for Medicare Part B, this plan may cover the deductible and/or the co-insurance amounts.
If you don’t already have a supplemental plan for Medicare Part B, you may consider purchasing a type of supplemental plan called a
Medigap policy to help cover the co-insurance amounts. A Medigap policy is health insurance sold by private insurance companies to fill the "gaps" in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs. Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay a premium to the Medigap insurance company, and the premium amounts will vary by company and by state.
You can obtain additional information on Medicare Part B by going to
www.Medicare.gov.
Part C - Medicare Advantage or Medicare Managed Care
Medicare Advantage Plans are health plan options (like an HMO or PPO) approved by Medicare and offered by private companies. These plans are part of Medicare and are sometimes called "Part C" or "MA Plans." Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. Medicare Advantage Plans provide your Medicare health coverage and usually Medicare drug coverage. They are not supplemental insurance plans.
Medicare Advantage Plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. At a minimum, these plans must cover all of the services that Original Medicare covers. However, each Medicare Advantage Plan can charge different out-of-pocket costs. These are usually
co-payments but there can also be co-insurance and deductibles. It’s important to call any plan before joining to find out the plan’s rules, what your costs will be, and to make sure the plan meets your needs.
In addition, Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (usually for an extra cost). Depending on the plan, you may need a referral to see specialists or you can only see doctors who belong to the plan or go to certain hospitals to get covered services.
In some plans, if you see a doctor or other provider who doesn’t contract or participate with the plan, your services may not be covered at all, or your costs will likely be higher. You should check with your doctors or hospital to find out if they accept the plan.
You can obtain additional information on Medicare Advantage Plans by going to
www.Medicare.gov.
Part D - Prescription Drug Coverage
Medicare offers prescription drug coverage (Part D) for everyone with Medicare. To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and the drugs that are covered. It is important to choose a Medicare
Prescription Drug Plan that meets your needs and that is compatible with your health coverage.
There are two ways to get Medicare prescription drug coverage:
- Medicare Prescription Drug Plans: These plans (sometimes called “PDPs”) add drug coverage to Original Medicare as well as some of the Medicare Cost Plans, Medicare Private Fee for Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
- Medicare Advantage Plans (like an HMO or PPO) or other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A and Part B coverage, including prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called "MA-PDs." Please see the Part C section above for additional information on Medicare Advantage plans.
Exact coverage and costs for each plan will vary, but a standard level of service is expected to be provided by each plan. Standard out-of-pocket costs include the following:
- Monthly premium — a monthly fee that varies by plan. You pay this in addition to the Part B premium
- Yearly deductible — the amount you pay for your prescriptions before your plan begins to pay. Some drug plans charge no deductible
- Co-payments or co-insurance — the amounts you pay for your prescriptions after the deductible. You pay your share, and your plan pays its share for covered drugs
- Coverage gap — Most Medicare drug plans have a coverage gap. This means that after you and your plan have spent a certain amount of money for covered drugs, there is no coverage from your plan up to a limit ($6,447.50). The limit doesn’t include the drug plan’s premium, only covered Part D drug spending. Prior to 2011, you would have paid 100% of the cost within the coverage gap. Starting in 2011, eligible Medicare Part D beneficiaries whose spending on Part D prescription drugs enters them into the coverage gap will receive a 50% manufacturer discount on the total cost of brand-name drugs and a 7% government subsidy on the total cost of generic drugs within the coverage gap. Once you get out of the coverage gap, you are responsible for 5% of all prescription drug costs
Some plans offer coverage during the gap for generic drugs. However, plans with gap coverage may charge a higher monthly premium. Remember to check with the plan first to see if your drugs would be covered during the gap.
You can obtain additional information on Medicare Part D by going to
www.Medicare.gov.
Private payer or commercial payer coverage will vary by individual patient plan. However, most payers typically cover VELCADE for indications approved by the FDA and when it is considered medically necessary.
Depending on your insurance plan, you can receive treatment with VELCADE in the physician office or in a hospital outpatient setting. Most commercial payers cover VELCADE under their medical benefit, while a few have VELCADE as a part of their pharmacy benefit. Sometimes prior authorization or other medical documentation is required.
Since coverage varies by each patient’s plan, it’s a good idea to confirm coverage with your specific insurance plan before you start therapy.
The VELCADE Reimbursement Assistance Program (VRAP), 1-866-VELCADE (835-2233), option 2, accepts calls from patients, caregivers, physicians, and other healthcare practice professionals. We will talk with you to find out more about your needs and how we can help.
While most insurance plans cover and reimburse for VELCADE, there may be instances when the insurance has denied coverage. Alternatively, in some cases the insurance has paid its portion, but the remaining out-of-pocket treatment costs are high. Regardless of the situation, for some patients and their families, out-of-pocket treatment costs may create undue financial or emotional strain. If you are having financial difficulty during your treatment with VELCADE, VRAP provides free education and counseling to connect you with programs that can help cover the cost of co-payments and deductibles.
For instance, VRAP dedicated Case Managers can help by:
- Investigating your insurance benefits and coverage options
- Working with you and your healthcare provider to appeal a denied claim or denied prior authorization request
- Referring you to foundations that can help offset your co-pay and other out-of-pocket medical expenses
- Identifying alternative and supplemental insurance coverage options.
VRAP is easily accessed by calling 1-866-VELCADE and selecting option 2. Dedicated Case Managers are available from 8:00 am to 8:00 pm, EST.
If you need help with investigating insurance benefits, please have your insurance card available when you call.
Medicaid Coverage
State Medicaid programs typically cover VELCADE for indications approved by the FDA and when it is considered medically necessary. Each state, however, state will apply its own coverage and payment policies. This could include requirements for prior authorization. Depending on the state Medicaid policy, patients can receive treatment for VELCADE either in the physician office or hospital outpatient setting. Almost all Medicaid agencies cover VELCADE under their medical benefit, while a few have VELCADE as a part of their pharmacy benefit. In addition, some Medicaid plans may require prior authorization.
Since coverage varies from state to state, it’s a good idea to confirm coverage with your specific Medicaid plan before you begin therapy.
If you need help in learning more about your Medicaid coverage for VELCADE, the VELCADE Reimbursement Assistance Program (VRAP) dedicated Case Managers can help you by:
- Investigating your insurance benefits and coverage options
- Working with you and your healthcare provider to appeal a denied claim or denied prior authorization request
VRAP is easily accessed by calling 1-866-VELCADE and selecting option 2. Dedicated Case Managers are available from 8:00 am to 8:00 pm, EST.
The hotline accepts calls from patients, caregivers, physicians, and other healthcare practice professionals. We will talk with you to find out more about the patient’s needs and how we can help.
Uninsured or Underinsured
If You Have No Insurance:
VELCADE Reimbursement Assistance Program (VRAP) dedicated Case Managers can help you by researching alternative options for insurance and funding.
If you have no insurance coverage for VELCADE, you may be eligible to participate in the Patient Assistance Program. If you qualify for the program, free VELCADE product will be delivered to your treating physician.
Eligibility for the VELCADE Patient Assistance Program is based on several criteria, including such factors as:
- Household income
- Treatment setting
- U.S. residency
- Confirmation that VELCADE is prescribed for a use that is medically appropriate
VRAP is easily accessed by calling 1-866-VELCADE and selecting option 2. Dedicated Case Managers are available from 8:00 am to 8:00 pm, EST.
The hotline accepts calls from patients, caregivers, physicians, and other healthcare practice professionals. We will talk with you to find out more about the patient’s needs and how we can help.
If You Have Insufficient Insurance:
Sometimes, insufficient insurance coverage prevents a patient from receiving the physician’s treatment of choice. That could be due to limited coverage benefits or high out-of-pocket costs.
If that is the situation you face, VRAP dedicated Case Managers may help by:
- Referring you to foundations that may be able to help offset your co-pay and other out-of-pocket medical expenses
- Identifying alternative and supplemental insurance coverage options
VRAP is easily accessed by calling 1-866-VELCADE and selecting option 2. Dedicated Case Managers are available from 8:00 am to 8:00 pm, EST.
The hotline accepts calls from patients, caregivers, physicians, and other healthcare practice professionals. We will talk with you to find out more about the patient’s needs and how we can help.
Co-payment Resources
Co-payment foundations are available to help underinsured patients who cannot afford the costs associated with their drug coverage. They are non-profit organizations, and the monetary assistance will vary among the different foundations.
Co-payment Assistance Eligibility
Criteria for patient eligibility vary among co-payment foundations, but can include:
- Specific disease states
- Financial eligibility based on a percentage of federal poverty level
- Type of insurance
- U.S. citizenship/residency
Co-payment foundations that may be able to offer assistance for patients with multiple myeloma and relapsed mantle cell lymphoma include the following:
Patient Advocate Foundation
www.patientadvocate.org
Phone: (800) 532-5274
HealthWell Foundation
www.healthwellfoundation.org
Phone: (800) 675-8416
Patient Access Network Foundation
www.panfoundation.org
Phone: (866) 316-7263
Chronic Disease Fund
www.cdfund.org
Phone: (877) 968-7233
Leukemia and Lymphoma Society
www.lls.org
Phone: (800) 955-4572
The Assistance Fund
www.theassistancefund.org
Phone: (877) 245-4412
The dedicated Case Managers at the VELCADE Reimbursement Assistance Program (VRAP) can assist you through the application process for co-payment assistance by calling 1-866-VELCADE and selecting option 2 from 8:00 am to 8:00 pm, EST.