- Patient Assistance Programs: How To Get Help Paying For Your Prescriptions
- What Are Patient Assistance Programs?
- What Are The Requirements For Patient Assistance Programs?
- What Are The Benefits Of A Patient Assistance Program?
- How To Apply For A Patient Assistance Program
- Patient Assistance Programs Offered By Nonprofits.
- Pharmaceutical Companies That Offer Patient Assistance Programs
- State Pharmaceutical Programs
- The Connecticut Pharmaceutical Assistance Contract to the Elderly and the Disabled Program provides help to seniors 65 and older and individuals with a disability who are not eligible for Medicare.
- North Carolina
- New Jersey
- New York
- Oregon’s CAREAssist program offers help to patients with HIV/AIDS.
- Rhode Island
- U.S. Virgin Islands
Patient Assistance Programs: How To Get Help Paying For Your Prescriptions
In this guide, I will talk to you about patient assistance programs and how they can help you to cover the cost of your prescription drugs. Now more than ever patients need help paying for medications because the cost of prescription drugs has increased 33% since 2014! I’m Nick Bryant, founder of HoustonCaseManagers.com, where I help clients and medical professions find resources like affordable medications. Today I will talk to you about patient assistance programs. These are programs that help low-income uninsured patients pay for the cost of their prescriptions.
- After you are done reading this guide you will have a better understanding of the following topics:
- What type of help patient assistance programs offer
- The requirements to receive help paying for medications
- How to apply for a patient assistance program
- Types of patient assistance programs (nonprofits, pharmaceutical companies, state-sponsored programs)
There is a lot to cover, so let’s get started!
What Are Patient Assistance Programs?
Patient Assistance Programs (PAPs) are programs that help low-income patients pay for the cost of their prescriptions. These medication assistance programs are typically offered by pharmaceutical companies, health and human service departments, or nonprofits. The programs are offered as a safety net to ensure that individuals who are considered low-income or uninsured are able to afford their medications. Having insurance does not guarantee that an individual will be able to afford their prescriptions, because even individuals with employer health insurance, Medicare, and Medicaid sometimes need assistance with the cost of medications. Even with these types of insurance, many people are still burdened by the coverage gaps and formulary restrictions. This is where the Patient Assistance Programs step in to provide financial assistance to help those patients obtain their prescriptions for little or no cost.
What Are The Requirements For Patient Assistance Programs?
The eligibility requirements for patient assistance programs differ from company to company, so there’s no standard set of qualifications. While the eligibility varies with each organization, these are general requirements that you can expect:
Most patient assistance programs help patients who are considered to be low-come. Whether you are eligible or not for a prescription assistance program will depend on where you fall on the Federal Poverty Level Chart. Most assistance programs (food stamps, public housing, etc) use Federal Poverty Level to determine eligibility, and patient assistance programs are no different.
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A patient’s out-of-pocket costs for medications could be another factor to determine your eligibility for patient assistance. Even with health coverage, some prescriptions are still difficult to afford, especially Tier 3 and 4 drugs.
Editor’s note: There are 4 tiers of prescription drugs. Tier 1 is the least expensive and 4 is the most expensive and used to cover very serious medical conditions.
If your monthly income is not enough to cover the cost of your meds, this could qualify you for helping paying for prescriptions.
Approval From Your Doctor
In most instances, you simply need to provide a prescription to qualify for a patient assistance program. Other times you may need documentation from your doctor validating your medical condition and the need for the prescription.
Health Insurance Requirements Differ With Each Patient Assistance Program
Health insurance is a requirement for some patient assistance programs. These programs will not cover the entire cost instead, they pledge to help with things like a copay, therefore you would need to have health insurance to qualify for these programs. The Healthwell Foundation is one of these programs. While working through their pre-screening questions, you are asked about whether or not you have health insurance. If you answer no to this question the interview will stop and they will explain that you have to have health insurance to qualify. Again not every patient assistance program requires health insurance, however, there are some that mandate this. It is also important to note that the majority of these programs do not consider age as a factor for eligibility. Other aspects, such as marital status, do not really affect eligibility. In terms of geographical placement, the participants need to reside in the United States or have a shipping address within the United States.
What Are The Benefits Of A Patient Assistance Program?
In general patient assistance programs help with the cost of medications. You may be wondering but how? Below are some of the ways that these medication assistance programs can help you to afford meds:
- Paying for the cost of your medication or immunization if you do not have health insurance
- Offering you discount coupons that you can redeem at your local pharmacy
- Shipping free prescriptions directly to you
- Reimbursements of the costs or a percentage of the costs of your medication
The amount of assistance that you receive can depend on your income. Someone making $12,000 a year may qualify for a 100% discount on medications, while an individual making $21,000 may only receive a 15% discount. The amount of your discount will depend on which organization you apply for assistance with. Another thing that differs with each organization is how long you qualify for assistance. Some organizations like GSK offer help paying for medications on an annual basis. Once that year is up you will have to reapply again if you wish to receive more assistance. Other organizations will require that you reapply for assistance after 90 days or with each new medication assistance request.
How To Apply For A Patient Assistance Program
How you apply for a patient assistance program will depend on where you are applying at. There are 3 different types of patient assistance programs and below I will provide you with a listing and a brief summary of how to apply.
- Nonprofit Patient Assistance Programs – These programs will first ask you a series of questions. Depending on your answers you will either be directed to programs that you qualify for or someone with the nonprofit will contact you to help you apply for a medication assistance program.
- Pharmaceutical Companies – These companies offer many assistance programs to low-income patients. To apply you simply need to visit the website of the pharmaceutical company that manufactures the medication and apply online.
- State Pharmaceutical Assistance Programs – If you are applying for a state-funded patient assistance program, this typically goes through the state Health and Human Services Department. You will need to apply through this agency for a state pharmaceutical assistance program.
Editor’s note: You will learn more about each of the above patient assistance programs below, so keep reading.
What Information Is Needed To Apply For A Prescription Assistance Program?
The information that is needed will depend on the program, but this is a general listed of items that are needed.
- Proof of income (to show you are a low-income patient)
- Proof of residency
- Health insurance (some programs require health insurance, other programs do not)
- Prescriptions (you must be taking the medication that you are requesting financial assistance for)
- Medical information
8 Tips For Applying For A Patient Assistance Program
Patient Assistance Programs Offered By Nonprofits.
If you are having trouble paying for prescriptions, these patient assistance programs can potentially help you. While some patient assistance programs are difficult to apply for the following websites are all very easy to navigate and in many cases offer a telephone number for you to call to receive help. Read more about each to learn the features of each to see which is the best fit for your situation.
Healthwell is a nonprofit that helps low-income, underinsured patients pay for their medications.
Editor’s note: Healthwell Foundation cannot help you if you are uninsured. They help to cover the cost of copayments and coinsurance, therefore you must have insurance to receive help from Healthwell.
The Healthwell Foundation provides assistance in the form of a 12-month grant that is used to pay for medications. You can search for assistance based on medications or specific medical conditions found on their “Disease Funds” page. Some of those diseases include:
- COVID-19 insurance premium payment assistance
- Cystic Fibrosis treatment
- Hepatitis C
- Prostate Cancer
- Small cell lung cancer
Many patient assistance applications can be confusing, however, this is not the case with Healthwell. Their application process is straightforward and tells you whether you qualify for help with medications or not.
GSK Patient Assistance Program
GSK offers help paying for prescriptions, vaccines, copayments, and oncology products. Eligibility is based on a number of factors, however, a general requirement is a patient NOT have prescription coverage. You can use the GSK eligibility survey to see if you qualify for assistance. This is a 3-step process that makes finding a patient assistance program very easy.
RX Assist makes it very easy to search for patient assistance programs. You can do so by simply using their database search and typing in the name of a specific drug or pharmaceutical company name. You can contact RX Assist via email at firstname.lastname@example.org.
Needy Meds is a very thorough resource when it comes to prescription cost assistance. They offer a “drug search” which allows you to find patient assistance programs, coupons, rebates, and other discounts to help you pay for medicines. Other helpful features of this site include newsletters and weekly webinars to help you better understand how patient assistance programs work. If you are serious about learning how to save money on the cost of medications, Needy Meds is definitely a website that you should bookmark. To learn more about the help they provide, call their helpline at 800.503.6897.
The PAN Foundation helps you to find patient assistance programs that you qualify for based on disease or a specific medication that you are taking. Like the other patient assistance programs in this section, the PAN Foundation makes it very easy to learn about programs that you could qualify for. You can use their 3-step eligibility form or search their “disease fund” to see which conditions they cover. For more information about the PAN Foundation, you can visit their website, email them, or call 866.316.7261.
Pharmaceutical Companies That Offer Patient Assistance Programs
Another way to find help paying for the cost of medications is going straight to the manufacturer. The companies who make the medications that you take likely offer patient assistance programs of their own, therefore if you need help affording your prescriptions you are encouraged to look up the manufacturer. Below you will find 2 pharmaceutical companies that offer patient assistance programs. You will also find a Medicare search that allows you to find pharmaceutical companies that offer help paying for prescriptions.
Pfizer Patient Assistance Program
The Pathways program offers a number of programs to help eligible patients cover the cost of prescription drugs.
- Pfizer Patient Assistance Program – This provides free Pfizer medications to eligible patients. To learn more about this program call 866.706.2400 or visit the Pfizer website.
- Pfizer Savings Program – This helps uninsured individuals save money on Pfizer prescriptions at their pharmacy. You can call 855.239.9869 or visit the Pfizer website and scroll down to “Pfizer Savings Program”.
- Pfizer Institutional Patient Assistance Program – Uninsured patients can receive free Pfizer prescriptions via their local federally qualified health centers. To learn more about your local clinics that participate in this program visit the Pfizer website, scroll down to “Pfizer Institutional Patient Assistance Program”, and type in your zip code.
- Treatment -Specific Patient Support Hubs – Specific Pfizer medications offer help to their patients. You will need to visit the Pfizer website, scroll to “Treatment-Specific Patient Support Hubs” and use the drop-down menu to find your medication.
- Co-Pay and Savings Offers – Co-Pay and savings cards help patients to save money on brand-name medications. There is no maximum income for this savings program. To learn more visit the Pfizer website and scroll down to “Co-pay and Savings Offers”.
You can also use the Pfizer search tool to find your medication and see if they provide any assistance.
Novo Nordisk Patient Assistance Program
The Novartis patient assistance program provides a 90 day supply of insulin to diabetic patients who qualify. In addition to helping individuals with diabetes Novo Nordisk also offers assistance programs to help patients who are obese, have a rare blood disease, or a condition that that impacts the endocrine system. To learn how to qualify for this program see the HoustonCaseManagers.com guide titled Novo Nordisk PAP: How to get a Free 90 Day Supply of Insulin.
Johnson and Johnson Patient Assistance Program
Johnson and Johnson offers a patient assistance program that helps uninsured patients afford the cost of prescription drugs. Some of the medications that this prescription assistance program offers are:
- Risperdal Consta
You can search for more medications that Johnson and Johnson offer on their website. To apply for the Johnson and Johnson Patient Assistance Program you and your primary care doctor will need to complete an application. For questions about this program call 800.652.6227.
Merck Patient Assistance Program
Merck is a pharmaceutical company that offers a patient assistance program to help cover the costs of medicines and adult vaccines. Currently, there are 40 products in the Merck Patient Assistance Program that they cover. A few of those are:
To learn more about Merck’s prescription assistance program call 800.727.5400 or visit their website.
State Pharmaceutical Programs
You can also find help paying for medications through State Pharmaceutical Assistance Programs (SPAP). These programs are sponsored by each state and provide residents with help paying for prescription drugs and other medical costs like dialysis and HIV/AIDS treatment. These programs are run by each state’s Health and Human Services Commission. To apply you would need to contact your state’s Health and Human Services Department. Below is a list of State pharmaceutical Assistance programs:
The Centennial State offers one prescription assistance program called the Colorado AIDS Drug Assistance Program (ADAP). This program provides help to individuals with HIV/AIDS. To learn more about this Colorado pharmaceutical assistance program call 303.692.2716 or visit the Colorado Department of Public Health website.
To apply for this program you can call 800.423.5026 or visit the Connecticut Department of Aging and Disabilities website.
Delaware has one program that helps with dialysis. That program is called the Delaware Chronic Renal Disease Program. To apply, call 302.424.7180 or visit the Delaware.gov website.
Idaho has a program called the Idaho AIDS Drug Assistance Program (ADAP). This prescription assistance program helps individuals in the state who have a diagnosis of HIV/AIDS. To learn more call 208.334.5612 or the Idaho Department of Health and Welfare website.
Montana offers two state pharmaceutical assistance programs which are: Big Sky Rx Program helps Medicare beneficiaries with the cost of medications. To learn more you can call 406.444.3565. The other program is Montana AIDS Drugs Assistance Program (ADAP). This Montana program assistance individuals with HIV/AIDS.
North Carolina offers a state pharmaceutical assistance program that helps individuals with HIV/AIDS. To learn more about the North Carolina AIDS Drug Assistance Program call 877.466.2232.
New Jersey has two assistance program: Senior Gold Prescription Discount Program helps seniors 65 and older and individuals 18+ who receive Social Security Disability Insurance benefits. The Pharmaceutical Assistance to the Aged and Disabled (PAAD) also helps seniors 65 and up and those 18+ with SSDI. To apply for either New Jersey pharmaceutical assistance program you can call 800.792.9745.
Nevada offers a Senior Rx program to help individuals who qualify for Medicare. For more information, you can call 775.687.0539.
New York has one state program called Elderly Pharmaceutical Insurance Coverage (EPIC). Seniors 65+ can potentially qualify for this program. To apply you can contact 800.332.3742.
Oregon’s CAREAssist program offers help to patients with HIV/AIDS.
To apply you can call 971.673.0144.
The Pennsylvania Department of Aging offers 4 pharmaceutical programs. Medication assistance is offered to seniors 65 and older through the Pharmaceutical Assistance Contract for the Elderly (PACE). To apply for this program you can call 800.225.7223. The Pennsylvania PACE Needs Enhancement Tier (PACENET) is the same as the medication assistance program above, however, it helps seniors 65 and older with slightly higher incomes. You can contact 800.922.9384. The Special Pharmaceutical Benefits Program (SPBP) assists Pennsylvania residents who have HIV/AIDS diagnosis. To apply for this program call 800.922.9384. Lastly, if someone needs help covering the cost of dialysis the Chronic Renal Disease Program (CRDP) can help. To learn more about this diabetes assistance program in Pennsylvania contact 800.225.7223.
Rhode Island has a program that assists seniors 65+ and those with disabilities 55-65 who receive SSDI with medication assistance. The program is called the Rhode Island Pharmaceutical Assistance to the Elderly Program (RIPAE). To apply for this program call 401.462.3000.
Texas offers a dialysis and HIV/AIDS assistance program. The Texas HIV Medication Program helps those with a diagnosis of HIV/AIDS. To apply you can call 888.311.7632. If you need help with dialysis the Kidney Health Care (KHC) is available. To learn more you can call 800.222.3986 or 512.776.7150.
The AIDS Drug Assistance Program (ADAP) assists individuals with HIV/AIDS. To apply for this program call 855.362.0658.
Medicare Beneficiaries with Part D plans can get help with the cost of medications through the Healthy Vermonters and VPharm Program. To learn more you can call 800.250.8427.
There are 2 assistance programs in Wisconsin; Senior Care and Wisconsin Chronic Disease Program. The SeniorCare Program helps individuals 65 and older with prescription assistance. To apply for this program call 800.657.2038. The Wisconsin Chronic Disease Program helps individuals with renal disease, hemophilia, or cystic fibrosis. You can learn more about this program by contacting 800.947.9627.
U.S. Virgin Islands
Seniors 60 and older can receive help paying for medications via the Senior Citizen’s Affairs Pharmaceutical Assistance Program. You can apply by contacting the Department of Human Services in St. Thomas (340.774.0930), St. Croix (340.718.2980), or St. John (340.776.6334).
If you are having trouble paying for medications consider patient assistance programs as a potential solution. These programs are offered by nonprofits, pharmaceutical companies, and health and human services departments. Based on the programs mentioned in this guide which do you think is the best fit for you? Leave your comment below or feel free to ask more questions and I will respond.
Nick Bryant is a Counselor with 11 years of experience working in community health. He enjoys concerts, walks with the doggo and wife, mocking Dallas Cowboy fans, and sharing community resources. Jump on the Houston Case Managers email list to receive weekly community resource guides delivered directly to your inbox.