NEW Brandname Medication & Supplies Now Available in TPC

As new medications are approved by the FDA and become available on PAP(s), they are added to TPC. We continue to make updates regularly. Check out some of the most recent additions. Don’t forget to share these newly available products with your providers so they are aware of new medication/supply options when considering what to prescribe for patients based on their condition(s).

Dexcom G6 Transmitter & G6 Sensors (Endocrine/Metabolism)

Leqembi (Neurologic – Dementia/Alzheimer’s Disease)

Qelbree (Psychiatric – ADHD)

Tivdak (Hematology/Oncology)

Vyndamax (Cardiovascular)

Welireg (Hematology/Oncology)

Additional updates to PAPs such as available medications/supplies, program notes, form changes, and more can be located under Program Changes in TPC. The most recent changes are listed first.

Just Launched TPC Features

A new substitute medication feature is now available in TPC! This makes alternative medication options available via PAPs visible in a new screen without having to maintain separate lists previously distributed by TPC staff. We also have a new program eligibility report that displays one or more manufacturers eligibility requirements with the ability to export to excel for additional sorting options and easily access program contact information and portal links right from the report.

The U.S. Federal Poverty Guidelines used to determine financial eligibility have changed for 2023 and the quarterly update to medication prices has been deployed. Previews of additional upcoming enhancements will be made available at the Spring Roundtables in late April/early May!

Highlights of Important PAP Updates for Patients & Providers

TPC sends out regular communication via email with important changes to PAPs. We also use the time during the monthly technical support calls to discuss challenges, solutions, new ideas and more when it comes to assisting patients in need. Check out some of the most recent updates.

Pfizer RxPathways has recent changes effective January 1, 2023. These include:

patients must meet the new income eligibility requirement of 300% FPL (previously 400% FPL) and 500-600% FPL for Specialty and Oncology products and there will be no income exception process;
commercially insured patients are not eligible for the PAP, regardless of their income status or medicine’s formulary status;
medicines accessed through the PAP must be for an FDA-approved indication

Visit pfizerrxpathways.com/updates for more information about these updates and how they may affect currently enrolled patients.

Johnson & Johnson Patient Assistance Foundation (JJPAF) no longer assists patients with insurance, effective January 1, 2023. Patients who do not have insurance coverage are still eligible to apply to the JJPAF. A new program, Janssen, is available to patients with commercial, employer-sponsored, or government coverage (i.e.: Medicare, Medicaid, TRICARE, etc.) and offers the products that were previously available through JJPAF to insured patients and is available in TPC. To learn more about this program, visit newprograminfo.com.

Starting in early February 2023, Novo Nordisk is phasing out Levemir FlexTouch (NDC: 0169-6438-10) and it will be replaced with the Levemir FlexPen (NDC: 0169-6432-10) which can deliver up to 60 units of insulin per single injection. This product is not new to TPC and has been available. Be sure your providers and patients are aware of the slight difference in products and providers will need to switch patients to the Levemir FlexPen. Levemir FlexTouch will continue to ship while supplies are available. To access available resources, visit LevemirPro.com.

As of February 20, 2023, Latuda will no longer be available from the Sunovion Support Prescription Assistance Program for currently enrolled patients. Eligible patients may receive a final prescription refill of up to 90-days to assist during this transition to an alternate medication or other possible means of support. Please note that final refill orders must be processed on or before February 20, 2023. Patients and healthcare providers should discuss medication options after the last prescription refill. Check out the new Substitute section of TPC for other alternative options available on PAPs!

Viatris has extended eligibility for currently enrolled patients approved for Lyrica, Lyrica CR and Dilantin. Individuals currently enrolled with commercial insurance will no longer be eligible for assistance after June 30, 2023. Enrollment will continue until the patient’s enrollment date ends or June 30, 2023, whichever comes first. Those with prescription coverage through a government program will no longer be eligible for assistance after December 31, 2023. No new patients are being accepted into the PAP for these products. Questions regarding your enrolled patients can be directed to Viatris at 1-888-417-5782.

Save the Dates for Upcoming Training & Monthly Support Calls

Sign up for an online TPC training session if you are new to your organization and need to learn the basics. If you currently use TPC and are looking to refresh your skills or want to learn about additional features, sign up for Advanced Training.

We also host monthly calls where we provide updates and give users the opportunity for a Q & A session. It’s also a great opportunity to brainstorm and learn from other TPC users. All sessions are Eastern Standard Time. Be sure to check the website for additional dates or to coordinate special training for a large group!

TPC Beginner Training

February 9 ^th (10am – 12pm)

March 7 ^th (10am – 12pm)

April 11 ^th (1pm – 3pm)

TPC Advanced Training

February 22 ^nd (1pm – 3pm)

April 27 ^th (2pm – 4pm)

Monthly Support Calls (10 – 11 am)

February 15 ^th

March 15 ^th

April 19 ^th

Check out some of the most Frequently Asked Questions in TPC!

PAP Conference Scholarship Opportunity Available

Apply by February 10th!

Informa Connect is hosting its 24th annual Patient Assistance & Access Program conference March 20-22, 2023, and will be offered as a hybrid event with the opportunity to attend in person in Philadelphia, PA or virtually. The conference is typically attended by pharmaceutical manufacturers, co-pay foundations, advocates representing hospitals, health systems and non-profit organizations. The demand for patient assistance continues to grow and this year’s conference will provide information on the evolving landscape of PAPs and industry trends with the opportunity to attend sessions on policy changes and patient access, patient adherence and technology innovations. Read more about the conference and what’s planned on the agenda.

If this material is of interest to you, you may be eligible to apply for a scholarship that includes one complimentary conference registration. To be eligible to apply, you must be a non-profit free healthcare clinic, advocacy group or patient organization. Organizations must have 501(c)(3) tax-exempt status. Scholarships are limited to one (1) representative from each organization. Hotel and other travel accommodations are the responsibility of the attendee(s). If you are interested in applying, please visit the scholarship page and submit your application before February 10th! Questions about the conference or scholarship? Please reach out to Allie Spica at alexandra.spica@informa.com.

Important Information and Assistance for Virginia Organizations

Medicaid Renewals are Coming!

During the pandemic, the Virginia Department of Medical Assistance Services (DMAS) allowed Virginians to retain Medicaid coverage without having to renew their eligibility each year. Beginning April 1st, DMAS will have 14 months to determine if all 2.1 million Virginians who are currently covered by Medicaid/FAMIS are still eligible.

Thanks to automated eligibility systems, DMAS will be able to complete some Medicaid/FAMIS members’ renewal automatically (called an ex parte renewal), but many currently covered by Medicaid will need to provide more up-to-date information to ensure a successful renewal. Ensure that your patients/clients with Medicaid/FAMIS coverage update their contact information so that they can receive mail from the state about their Medicaid/FAMIS renewal at the appropriate time.

If a Medicaid/FAMIS member has moved or changed phone numbers since 2019, they can report this important change:

To their Medicaid/FAMIS health plan, aka Managed Care Organization (MCO)
Online at commonhelp.virginia.gov
By calling the local Department of Social Services
By calling Virginia’s One Benefits line at 1-833-5CALLVA.

Beginning April 1st, Medicaid/FAMIS members should be on the lookout for mail from DMAS letting them know about next steps to ensure their Medicaid/FAMIS coverage can continue if they are still eligible.

Don’t forget that new & renewal Medicaid applications and their status can be tracked through TPC! For assistance with this feature and reporting capabilities, please reach out to TPC staff.

Virginia Medicaid has rebranded and is now called Cardinal Care!

Beginning in 2023, Virginia’s two managed care programs – Medallion 4.0 and Commonwealth Coordinated Care Plus (CCC Plus) – will be combined into one program, Cardinal Care Managed Care! This change will help reduce transitions or gaps in care if a member’s needs change and streamline credentialing for providers.

Beginning in January, those enrolling in Virginia Medicaid/FAMIS for the first time will receive Cardinal Care cards. Existing members will receive the new Cardinal Care card later in the year and should continue to use their old, blue-and-white Virginia Medicaid ID cards and Managed Care Organization (MCO, or Medicaid/FAMIS health plan) card until their new Cardinal Care card arrives.

One key change under Cardinal Care will be the availability of care coordination for all Medicaid/FAMIS members, if needed. The core benefits available to Medicaid members will remain the same under Cardinal Care. The same 6 MCOs (Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Molina Healthcare, Optima Community Care, UnitedHealthcare Community Plan, and Virginia Premier) will continue to offer services. Learn more about Cardinal Care here.

Affordable Connectivity Program (ACP)

Available to Virginia Families

This new federal program can help families pay for broadband service and internet-connected devices. Eligible families can receive:

Up to $30/month discount for broadband service;
Up to $75/month discount for households on qualifying Tribal lands; and
A one-time discount of up to $100 for a laptop, desktop computer, or tablet purchased through a participating provider, so long as the household contributes between $11 – $49 toward the purchase price.

The ACP is limited to one monthly service discount, and one device discount per household. A household is eligible for the ACP if its income is at or below 200% of the Federal Poverty Level (FPL), or if a member of the household meets at least one of the criteria outlined here. For more information and full details, visit fcc.gov/acp, or call 877-384-2575.

SignUpNow Announces New Winter/Spring 2023 Workshops

Do you work with clients who are 65+ years old, enrolled in or eligible for Medicare and/or need assistance with renewal of their Medicaid eligibility? SignUpNow now offers 2 training workshops on how to help these individuals apply for and renew their eligibility for Medicaid!

Workshop dates and registration is available at vhcf.org/workshops.

SignUpNow – Medicaid/FAMIS workshops cover the “ins and outs” of the eligibility requirements, application procedures, and post-enrollment information for Virginia’s Medicaid/FAMIS programs for children and families, including:

New Adult Coverage (“Medicaid Expansion”)
Programs for children and pregnant women (FAMIS, FAMIS Plus, FAMIS Prenatal, FAMIS MOMS, and Medicaid for Pregnant Women)
Low Income Families with Children (LIFC)
Medicaid for Former Foster Care Youth
Plan First (family planning)

SignUpNow – ABD workshops cover eligibility requirements, application procedures, and post-enrollment information for Virginia’s Aged, Blind, or Disabled (ABD) Medicaid covered groups, including:

ABD with Income ≤80% FPL
Virginians who receive Supplemental Security Income (SSI) or an Auxiliary Grant
Medicare Savings Programs (Qualified Medicare Beneficiary, Special Low-Income Medicare Beneficiary, etc.)
Virginians needing Long-Term Services and Supports (LTSS), including those who are Institutionalized, in Hospice, or receiving Community Based Care.