In a move to make respiratory medications more affordable, AstraZeneca announced a $35 monthly cap on out-of-pocket costs for its inhaler portfolio, which includes Symbicort (budesonide and formoterol fumarate dihydrate). This cap became effective on June 1, 2024, and applies to different patient groups based on their insurance coverage. Navigating the specific eligibility rules is crucial for patients seeking to reduce their prescription costs. For many, the $35 savings card is the pathway, but those with government-funded insurance programs have a different, but equally important, path to explore.
Eligibility for the $35 Savings Card
Broadly, the $35 Symbicort program is intended for two main groups of patients: those with commercial insurance and those who are uninsured. The terms and conditions for this offer explicitly state that patients with government-funded insurance are not eligible for this specific savings card.
Commercially Insured Patients
If you have commercial health insurance—such as a plan from your employer or one purchased through the federal or state marketplace—you may be eligible for the $35 copay cap. The process for accessing this discount varies. Some participating pharmacies may automatically apply the discount when they process your prescription. For others, you may need to visit the AstraZeneca patient support website to download and use a savings card.
It is important to note that certain restrictions apply. For example, some states may have additional rules regarding savings programs, particularly if a generic equivalent of the medication is available. You should always review the specific terms and conditions on the savings card or program website.
Uninsured Patients
Patients without any health insurance are also eligible for the $35 monthly cost for Symbicort. To receive this benefit, uninsured patients must obtain a savings card from the AstraZeneca patient support website. The process involves confirming your status as an uninsured U.S. resident. After registering, you can download the card and present it to your pharmacist when filling your prescription.
Understanding the Limitations of the $35 Program
Federal law prohibits manufacturers from offering direct copay or discount card support for patients enrolled in government-funded programs. This means if you are covered by any of the following, you cannot use the $35 savings card:
- Medicare Part D
- Medicaid
- Medigap
- Veterans Affairs (VA) programs
- Department of Defense (DOD) programs
- TRICARE
Even if you are on one of these plans and try to pay cash for the prescription, you are still ineligible for the $35 savings card. These patients must pursue alternative avenues for prescription assistance, such as the AstraZeneca patient assistance program, AZ&Me.
The AZ&Me™ Prescription Savings Program: An Alternative
For those who do not qualify for the $35 savings card, particularly Medicare and other government-plan enrollees, AstraZeneca offers the AZ&Me™ Prescription Savings Program. This program provides free medication to eligible patients who cannot afford their prescriptions.
Eligibility for AZ&Me
- Income-Based: Eligibility is determined based on annual adjusted gross income, compared against the Federal Poverty Level (FPL). For primary medications like Symbicort, the income must be at or below 300% of the FPL.
- Insurance Status: The program is designed for uninsured patients and for Medicare enrollees who have high out-of-pocket costs and are not eligible for Medicare's Low-Income Subsidy (LIS) program.
- Residency: Applicants must be residents of the United States and treated by a U.S.-licensed healthcare practitioner.
How to Apply for AZ&Me
Applying for the AZ&Me program typically involves submitting a formal application with supporting financial documentation. The application can be downloaded from the AZ&Me website or sent via mail or fax. If approved, patients receive their medication directly from the program for a set enrollment period, typically 12 months, with re-enrollment required annually.
Comparison of Symbicort Patient Assistance Options
To clarify the pathways to affordability, here is a comparison of the two primary programs offered by AstraZeneca for Symbicort users:
| Feature | $35 Savings Card | AZ&Me™ Prescription Savings Program |
|---|---|---|
| Eligible Patients | Commercially insured and uninsured U.S. residents. | Uninsured or underinsured U.S. residents; Medicare patients not receiving Extra Help (LIS). |
| Ineligible Patients | Government-funded insurance enrollees (Medicare, Medicaid, etc.). | Patients with commercial insurance that offers coverage; Medicare patients with Extra Help. |
| Cost to Patient | $35 per 30-day supply (1 inhaler). | Free medication for eligible patients. |
| Eligibility Criteria | Insurance status (commercial or none), U.S. residency. | Income level (at or below 300% FPL for Symbicort), insurance status, U.S. residency. |
| Application Method | Download a card from the manufacturer's website or may be automatic at pharmacy. | Submit a formal application with income documentation via mail or fax; phone applications available. |
| Renewal | Use a new card as needed, subject to terms. | Must re-enroll annually; eligibility reassessed. |
Conclusion
For patients seeking affordable Symbicort, determining the correct pathway to savings is essential and depends entirely on one's insurance status. Individuals with commercial insurance or no insurance can leverage the $35 monthly cap by obtaining a savings card directly from AstraZeneca. For those covered by government plans like Medicare or Medicaid, the $35 card is not an option due to federal regulations. Instead, these patients must turn to the AZ&Me Prescription Savings Program, which offers free medication based on income and other specific criteria. By understanding the eligibility rules and applying to the correct program, patients can significantly reduce their out-of-pocket costs and maintain consistent access to their necessary respiratory medication.
For more information and to confirm your eligibility, visit the official AstraZeneca US Patient Support website.
