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Access & Reimbursement

Health Insurance

The following information has been compiled as a central resource for information on access to care and reimbursement issues for Alphas who require assistance to ensure access to FDA-approved augmentation therapy products in the United States.

Augmentation Therapy Companiesplus

Each Alpha-1 augmentation therapy company has preferred providers that provide services to their Alpha-1 patients including assistance with reimbursement issues such as understanding their current insurance coverage, claims, and co-pay process.

Assistance with Accessplus

There are several companies who specialize in obtaining financial assistance and finding insurance for the un-insured to ensure access to augmentation therapy. In addition, each augmentation therapy company has a preferred provider to assist Alpha-1 patients on their product with reimbursement issues related to insurance coverage, Medicare and Medicaid.

Learn more about Assistance.

Specialty Pharmacy and Home Healthplus

Accredo Health Group, Inc.

Telephone: (866) 6-ALPHA-1 - (866) 625-7421

Preferred provider for: Baxter (Aralast NP®) and CSL Behring (Zemaira®)

Patient Services:

  • Specialty-trained pharmacists and nurses to provide proper
  • Alpha-1 patient education and care 24-hour access to clinical support for patients, their family members, and caregivers
  • A team of reimbursement specialists to help patients with insurance and claims.

BioRx

Telephone: (866) 44-BIORX - (866) 442-4679

Preferred provider for: Baxter (Aralast NP® & Glassia™) and CSL Behring (Zemaira®)

Caremark

Telephone: (800) 552-8159

Preferred provider for: Baxter (Aralast NP®)

Patient Services:

  • 24/7 access to a specially trained nurse or pharmacist
  • Culturally sensitive staff and multi-lingual capabilities
  • Comprehensive, individualized clinical support and coordination with physician
  • Personalized consultation on insurance coverage and reimbursement assistance
  • Convenient delivery of medications, supplies and waste disposal kits, including emergency response when needed

Dohmen Life Science Services

Telephone: (800) 305-7881 (Prolastin Direct)

Preferred provider for: Prolastin Direct (Grifols)

Patient Services:

  • Prescription Processing
  • Reimbursement assistance services
  • Nursing services Insurance verification and coordination
  • Specialized Pharmacy Services Care coordinated delivery services
  • Home Infusion with Alpha-1 certified nurses

Curascript, Inc.

Telephone: (888) 773-7376

Contact: Donna Nicholson at (407) 854-6549 for more information

Curascript is a service provider for Baxter and is a wholly owned subsidiary of Express Scripts, Inc.

Patient Services:

  • Patient care management programs
  • 24/7 clinical support
  • Patient assistance programs
  • Reimbursement services
  • Integrated delivery solutions

US Bioservices

Telephone: (888) 518-7246

Email: info@usbioservices.com

Preferred Provider for: Baxter (Aralast NP® & Glassia™)

US Bioservices delivers nationwide specialty pharmacy and nursing services for patients, physicians, payors and pharmaceutical manufacturers.

Medicareplus

There are some critical changes taking place with Medicare that will affect the Alpha-1 community. Most important is a recent announcement that Medicare Advantage plans may be canceled this year without the 90-day notice that normally applies. This could affect an Alpha’s augmentation therapy infusions and other essential coverage.

For 2015 stand-alone Medicare Part D plans, premiums are likely to be slightly higher, there will be fewer plan choices in most states, and a number of name changes for current plans.

Medicare Open Enrollment is the one time of year when anyone who has a Medicare policy can make changes to their health and prescription drug plans for the next year. For people with Alpha-1, this is your opportunity to be sure your Alpha-1 augmentation therapy will be covered in 2015.

To review coverage:

  1. Compile a list of all your prescribed medications and dosages.
  2. Verify that your medications are covered on next year’s plan. Here are helpful resources to assist you:
  3. Enroll in Parts A and B
  4. Enroll in Parts C and D (Medicare Advantage Plans and Part D) 
  5. Use the online ‘Medicare Plan Finder

For personalized assistance:

  1. Medicare toll-free number: 1-800-MEDICARE (633-4227)
  2. State Health Insurance Counseling and Assistance Programs (SHIPs)

For more information:

The Alpha-1 Foundation Virtual Support Group hosted a webinar, Open Enrollment for Medicare and Private Insurance: How to choose the plan that will work for you.

Report Access to Care Issues Hereplus

As access to care issues are identified, we can take action and engage our grassroots advocacy network. If you are an Alpha patient and your physician has denied your augmentation therapy prescription or if your insurance company will no longer provide coverage for your augmentation therapy, please report it here or contact Barbee Bennington, Support Group & Program Coordinator at bbennington@alpha1.org or 1-855-351-6610.