@article{58783aedc22b433eba8af790e55e854a,
title = "Navigating the Complex Web of Prescribing Amyloidosis Therapeutics: A Primer",
abstract = "Advancement in the diagnosis and treatment of transthyretin amyloid cardiomyopathy has made great strides in recent years. Novel therapeutics for transthyretin amyloidosis such as tafamidis, patisiran, and inotersen have shown significant benefits in a not-so-rare disease but come with high listing price tags ranging from a quarter to more than a half million dollars per year. These costs create significant financial barriers for the majority of patients, especially those with existing Medicare insurance plans. Of 72 patients reviewed, 67% were Medicare beneficiaries. Financial assistance was explored for the majority, and 37 (51%) patients with Medicare Part D received financial assistance that reduced their copayments to $0. Only one-third of our patients were able to afford these medications without any forms of financial assistance. Of these patients, 4 (6%) had the highest copayments ranging from $13 000 to $15 000 per year. To navigate the complexities of prescribing and affordability in amyloidosis, a multidisciplinary team including a dedicated clinical pharmacist is crucial in guaranteeing patients{\textquoteright} success to secure these novel therapeutics. In this article, we discuss our experiences with prescribing, acquiring insurance authorizations, and financing these life-saving medications based on patient-specific insurance plans and socioeconomic status.",
keywords = "amyloidosis, inotersen, insurance benefits, patisiran, prealbumin, tafamidis, transthyretine",
author = "Hongya Chen and Pranav Chandrashekar and Katherine Fischer and Dayna Carlson and Urja Narayan and Jack Chen and Ahmad Masri",
note = "Funding Information: them had to apply for manufacturer{\textquoteright}s patient support programs for financial assistance that provided free medication (described in the next section). Only 3 (4%) patients were able to secure The Assistance Fund,15 which covered nearly 100% of the copayments for the entire year. Funding Information: Besides copayment assistance programs, manufacturers for tafamidis (VyndaLink),18 inotersen (Akcea Connect),19 and patisiran (Alnylam Assist)20 have patient support programs for financial assistance. If approved, these programs will directly provide free medications to eligible patients. Each program has its own set of income guidelines similar to charitable foundations that are not shared externally, which limits our ability to summarize these avenues. In our cohort, 21 (29%) patients needed manufacturer assistance for tafamidis as a result of unavailability of or ineligibility for other charitable foundation grants or manufacturers{\textquoteright} copayment programs. Of the 21 patients who applied for the VyndaLink program, 19 of them were approved. However, 7 of the applicants were initially denied given their income was higher than the program{\textquoteright}s maximum income threshold for coverage . Of them, 5 were able to successfully appeal by providing additional documentations of other monthly expenses to justify their need for assistance. The remaining 2 patients did not pursue the appeal process for personal reasons. Fortunately, patients on patisiran or inotersen with affordability issues were able to secure access to these medications via charitable foundations or manufacturer{\textquoteright}s copayment programs. Publisher Copyright: {\textcopyright} 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.",
year = "2022",
month = apr,
day = "5",
doi = "10.1161/JAHA.121.023895",
language = "English (US)",
volume = "11",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "7",
}