Can the ‘Uninsured Payment’ option be used for patients that are covered by government programs like Medicare, Medicaid, TriCare or the VA if the patient pays cash?
No, and the encouragement to use coupons or rebate cards with patients covered by government programs violates the Federal anti-kickback statute, Section 1128B(b) of the Social Security Act (the “Act”).
Why does it matter to the government if the patient pays cash and doesn’t use their insurance benefit?
A beneficiary of a government program, regardless of how the drug is paid for at the point of sale, may not participate in the Galderma CareConnect offer. The government has determined that subsidies provided to beneficiaries covered by government programs, such as co-pay assistance, present all the risks of fraud and abuse associated with kickbacks, including steering beneficiaries to particular drugs; increasing costs to government programs; providing a financial advantage over competing drugs; and reducing beneficiaries incentives to locate and use less expensive, equally effective products.
Can you tell me why some of your older products are not covered by the program or don’t have a cash option (i.e. DesOwen Lotion or Clobex® Spray 4.25 oz.)?
To ensure Galderma remains committed to the future of dermatology, some tough economic decisions were made specific to a few of our older products. Your patients can access the Clobex Spray in the 2oz size whether Commercially Unrestricted or Uninsured Payment. Similarly, DesOwen Lotion 60g is available on the Galderma CareConnect program for Commercially Unrestricted patients and Uninsured Payment.
If my patient gets a prescription for a Galderma product and they use a pharmacy that is in Galderma’s network, will they be guaranteed a Galderma quality product?
If your patient fills the prescription for a branded Galderma product in the GCC program and chooses to pay the relevant copay, they will receive the branded Galderma product. If the patient decides not to pay the copay and receives a generic alternative of a Galderma product, the patient will predominantly receive an authorized generic version of the Galderma product if they are filling the prescription at a Galderma affiliated independent network pharmacy. Given the complexities of the market and supply chain dynamics, this may not occur in every situation.
On the Galderma CareConnect Patient Savings Card, what is the difference between ‘Commercially Unrestricted’ and ‘Uninsured Payment’?
‘Commercially Unrestricted’ refers to a payment by a patient that has commercial coverage (excludes all government programs) through a pharmaceutical benefit plan and a specific product has no restrictions (PA, Step Edit, NDC block, HDHP). These patients are eligible for the copay as little as $0 or $35, depending on the product.
‘Uninsured Payment’ refers to a payment by a patient with a commercial pharmaceutical benefit plan that restricts or denies (PA, Step Edit, NDC Block, HDHP) access to a specific product OR to a patient that has no pharmaceutical benefit plan.
Which patients qualify for the uninsured payment of as little as $75 or $125? Will this program remove the need for prior authorizations?
For patients with a restricted commercial pharmaceutical benefit plan, the pharmacist can process as an “Uninsured Payment” (the patient may pay as little as $75 or $125) OR the HCP and pharmacist can process the applicable restrictions, making the patient eligible for the “Commercially Unrestricted” benefit (the patient may pay as little as $0 or $35), clearing the edit for future refills for as little as $0 or $35. For patients without a commercial pharmaceutical benefit plan, the pharmacist can process as “Uninsured Payment” (the patient may pay as little as $75 or $125).
This program will not remove the need to process PAs or step edits to obtain the copay of $0 or $35.
Can this program be used at the large pharmacy chains (i.e. Walgreen’s, Target)?
Yes, Galderma CareConnect Patient Savings Card may be used at any participating pharmacy located in the United States, including the independent network pharmacies. Based on reimbursement policies of some major retail chains, a patient may be asked to pay more than the quoted copay at those pharmacies. The independent pharmacy chains are another option that may provide greater ease of use to your patients. Galderma is committed to ensuring that even patients with restricted access, and those that are uninsured, have access to the benefits of our products at a controlled price.
Will the independent pharmacy network have these offers? Will they have any unique offers or will it be the same exact offer that is in the market?
Yes, the independent pharmacy program offers have been harmonized to reflect the Galderma® CareConnect Program Patient Savings Card. The program is in effect in the Avella Network.
Is only the first fill of Epiduo® Forte Gel offered at as little as $0 or are the refills also covered at as little as $0 copay?
The current offer reflects that Epiduo Forte Gel is available for as little as a $0 copay on every fill for commercially unrestricted patients. If a patient has restrictions for this product or has no pharmaceutical benefit plan then the patient can fill the prescription for a copay as little as $75 for Epiduo Forte Gel on the first fill and each subsequent fill while the program is in place. The HCP and pharmacist can process the applicable restrictions, making the patient eligible for the “Commercially Unrestricted” benefit (the patient may pay as little as $0), clearing the edit for future refills at as little as $0.
What are the caps on the cards?
Galderma is dedicated to the practice of dermatology and has created a generous offer that will reimburse pharmacies for the full cost of the medication, less the patient’s payment, for the products listed on the Galderma CareConnect Program Patient Savings Card.
What if I give my patient a prescription for more than one Galderma product?
This program will work great in this instance. Because the Galderma CareConnect Program Patient Savings Card incorporates the portfolio of trusted Galderma products you prescribe, if your patient has valid prescriptions for more than one Galderma product, the savings apply to each product individually. Your patient may use the Patient Savings Card once every 30 days for each Galderma product, depending on when you last received a 30day supply of each Galderma product.
Will I need to give the patient a new card each month?
No, you only need to provide your patient with one card. Your patient will keep the card and provide it to the pharmacy each month along with the prescription and their pharmacy benefit card. If your patient has valid prescriptions for more than one Galderma product, the copay expense and savings apply to each product. Your patient may use the Patient Savings Card once every 30 days for each applicable Galderma product. This offer expires December 31, 2018, unless terminated earlier by Galderma.
What will happen if I call-in a new Galderma prescription for a patient that is currently using the Galderma CareConnect program?
When your patient goes to the pharmacy to pick-up the prescription(s), they will provide their Galderma CareConnect Program Patient Savings Card to the pharmacy along with their pharmacy benefit card for processing.
If a patient has a high deductible plan, will they get Epiduo® Forte Gel for as little as $0?
Patients with commercially unrestricted access to Epiduo Forte Gel should have as little as $0 copay. The patient will need to present the prescription, the Galderma CareConnect Program Patient Savings Card with their pharmacy benefit card to the pharmacist. If the patient has restrictions for Epiduo Forte Gel or has no commercial pharmaceutical benefit, Epiduo Forte Gel will be as little as $75. The HCP and pharmacist can process the applicable restrictions, making the patient eligible for the “Commercially Unrestricted” benefit (the patient may pay as little as $0 copay), clearing the edit for future refills.