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on the path to just 2 DOSES A YEAR
For Your Adult Patients with Schizophrenia
Why Wait for Another Relapse?
Government Coverage Options
For adult patients with schizophrenia and Medicare Part D Low-Income Subsidy (LIS) coverage,*† INVEGA SUSTENNA® may be just as affordable as generic oral options, with less than a $3 difference in monthly out-of-pocket cost1‡
Median out-of-pocket cost: $1.20 (IQR $0.00-$1.25) for oral antipsychotics vs $4.07 (IQR $3.80-$5.43) for INVEGA SUSTENNA®1,2§
Medicare Low-Income Subsidy (LIS)
Full-benefit, dual-eligible Medicare LIS & Medicaid patients pay
$0 to $10.35 per dose3||
Through the Medicare Part D Program
For adult patients with schizophrenia and Medicaid coverage, INVEGA SUSTENNA® may be just as affordable as generic oral options, with less than a $1 difference in monthly out-of-pocket cost4¶
Mean out-of-pocket cost: $0.61 (SD $2.43) for oral antipsychotics vs $0.86 (SD $4.78) for INVEGA SUSTENNA®4#
Medicaid
Medicaid fee-for-service patients may pay
less than $8 per dose5**
This information is not a promise of coverage or payment. It is not intended to give reimbursement advice or increase reimbursement by any payer. Legal requirements and plan information can be updated frequently. Contact the plan for more information about current coverage, reimbursement policies, restrictions, or requirements that may apply.
*All dual-eligible Medicare Part D beneficiaries (ie, those with Medicare and Medicaid coverage) also have LIS status. However, not all full LIS patients are dual-eligible.
†Inclusive of Medicare Part D full LIS in the pre-initial coverage limit (ICL) and ICL phases.
‡As demonstrated in 2 separate studies determining mean Medicaid out-of-pocket cost, or median Medicare out-of-pocket cost. Medicaid benefit may vary by state. The 2 starting doses of INVEGA SUSTENNA® have been factored into the mean and median monthly patient out-of-pocket cost calculations.
§The maximum that LIS beneficiaries paid in 2019 was $3.40 for generic drugs, and $8.50 for brand-name drugs, such as INVEGA SUSTENNA®. The maximum co-pay for generic oral antipsychotics was $3.40, and $8.50 for INVEGA SUSTENNA®.1
||See full eligibility requirements for the low-income subsidy for Medicare Prescription Drug Coverage: https://www.cms.gov/Medicare/Eligibility-and-Enrollment/LowIncSubMedicarePresCov/EligibilityforLowIncomeSubsidy
¶As demonstrated in a study determining mean out-of-pocket Medicaid cost. Medicaid benefit may vary by state. The 2 starting doses of INVEGA SUSTENNA® have been factored into the mean and median monthly patient out-of-pocket cost calculations.
#The Medicaid out-of-pocket cost range for generic oral antipsychotics is $0.00-$343.06. The Medicaid out-of-pocket cost range for INVEGA SUSTENNA® is $0.00-$348.41. 95% of patients on generic oral antipsychotics paid $3.13 or less, and 95% of patients on INVEGA SUSTENNA® paid $3.36 or less.6
**Above 150% of the Federal Poverty Level, patients may pay up to 20% of the amount the Medicaid agency pays. Medicaid Fee-for-Service is a state-specific program. Coverage for INVEGA SUSTENNA®, INVEGA TRINZA® (paliperidone palmitate), and INVEGA HAFYERA® (paliperidone palmitate) may depend on the indication as well as other factors. As this information varies by state, it is important to contact the state agency directly or consult its website to obtain product-specific coverage and other information.
SD=standard deviation; IQR=interquartile range.
Commercial Insurance
Janssen CarePath Savings Program can help eligible patientspay $10 per dose
with an $8,000 maximum program benefit per calendar year or 13 doses, whichever comes first
Not valid for patients using Medicare, Medicaid, or other government-funded programs to pay for their medications. Terms expire at the end of each calendar year and may change. There is no income requirement. Program does not cover the cost to give patients their injection. See full eligibility requirements at InvegaSustenna.JanssenCarePathSavings.com.
Online Enrollment of Patients in the Savings Program by You, the Pharmacy, Patient, or Caregiver
Providers and pharmacies can use Express Enrollment for the Savings Program at JanssenCarePathPortal.com/express
Patients and caregivers can enroll at MyJanssenCarePath.com/express
Janssen CarePath Is Your One Source for Access, Affordability, and Treatment Support for Your Patients
Janssen CarePath helps verify insurance coverage for your patients, provides reimbursement information, helps find financial assistance options for eligible patients, and provides ongoing support to help patients start and stay on prescribed INVEGA SUSTENNA®.
Visit
Questions? Call 855-452-6773 Monday–Friday, 8:00 AM–8:00 PM ET.
REFERENCES: 1. Li P, Benson C, Zhi Geng Z, et al. Out-of-Pocket costs for long-acting injectable and oral antipsychotics among full Low-Income Subsidy (LIS) Medicare beneficiaries with schizophrenia. Presented at: Psych Congress Elevate. June 3-5, 2022. 2. Data on file. Janssen Pharmaceuticals, Inc., Titusville, NJ. 2019. 3. Announcement of Calendar Year (CY) 2023 Medicare Advantage (MA) capitation rates and Part C and Part D payment policies. Centers for Medicare & Medicaid Services. April 4, 2022. Accessed January 31, 2023. https://www.cms.gov/files/document/2023-announcement.pdf
4. Lin D, Pilon D, Benson C, et al. PMH7: Assessment of patient out-of-pocket costs for antipsychotic treatments among Medicaid beneficiaries with schizophrenia. Presented at: ISPOR 2021; May 17-20. 2021; Virtual. 5. Cost sharing and premiums: Benefits. Medicaid and CHIP Payment and Access Commission. Accessed January 31, 2023. https://www.macpac.gov/subtopic/cost-sharing-and-premiums/ 6. Data on file. Janssen Pharmaceuticals, Inc., Titusville, NJ. 2019.