Note: In updating our blog post on prescription discount cards, we determined it would be more useful to our readers to split this material into several posts. Previously, we posted about prescription discount cards, manufacturer copay cards, and generic drug discount programs.
Over the past few weeks, we’ve brought you information on many different ways to save money on your prescriptions. But for patients with chronic, complex, or rare diseases, a discount card or temporary copay coverage may not be enough.
For example: cancer patients. With frequent doctor’s visits, surgeries, chemotherapy, and travel expenses, it’s not surprising that 63% of cancer patients struggle with the cost of care. Cancer medications – whether administered by IV at a treatment center or taken orally at home – can range from $100 to $65,000 a month. Patients faced with costs like these will need to look beyond coupons and $5 generics to afford their care. Oftentimes, special patient assistance programs can help.
Different entities provide different kinds of assistance. We’ll break down some of the most common ones below.
Drug manufacturer patient assistance programs
Most drug manufacturers provide some type of patient assistance program (PAP) for their brands. Eligibility is generally based on financial need. Most programs only accept patients who fall into one of the following categories:
- Patients with no insurance,
- Patients whose insurance does not cover the medication in question,
- Or patients who spend a certain percentage of their gross annual income on prescriptions.
Not sure where to find the right assistance program? Start with the Medicine Assistance Tool (MAT), created by the Pharmaceutical Research and Manufacturers of America. To use MAT, select your brand-name medication and provide a few pieces of preliminary information. The tool will then find programs for which you are eligible.
RxAssist is another useful search engine. After finding a program and clicking on the link, you’ll be able to see eligibility and application details at a glance.
If all else fails, searching the internet for a medication name plus the keywords “patient assistance” will usually bring up any existing PAPs for that drug or manufacturer.
Non-profits generally offer assistance programs organized by disease state, not by medication. Every non-profit will offer different funds with different grant amounts, so if one organization doesn’t have a program for your illness, don’t give up. Keep searching!
Non-profit programs usually require patients to have insurance that covers at least part of their care. Some programs are more restrictive and will only accept patients with certain kinds of insurance, such as Medicare, Medicaid, or military insurance.
To be eligible, patients generally must meet the following criteria:
- Be receiving treatment,
- Have health insurance,
- Need assistance for one of the medications covered by the program,
- Live in the United States or U.S. territory,
- And have an income that is less than or equal to 500% of the Federal Poverty Level. Patients can use online calculators to determine their percentage before beginning the application process.
Patient Access Network (PAN) Foundation: This non-profit assists insured patients with out-of-pocket prescription costs. Those out-of-pocket costs can include copays, deductibles, insurance premiums, and even travel costs. While PAN offers assistance programs for nearly 70 different disease states, not all programs are currently open for applications. Patients can use PAN’s FundFinder app to get instant notifications when a fund reopens.
Patient Services, Inc. (PSI): PSI can assist with the costs of infusion, nursing, and ancillary services in addition to the usual insurance premiums, prescription copays, and travel expenses.
Patient Advocate Foundation’s Co-Pay Relief Program: PAF provides direct payment to patients for copays, coinsurance, and deductibles. Their enrollment application can be completed online through a patient portal.
CancerCare Co-Payment Assistance Foundation: Specifically for cancer patients, this program provides copay assistance. However, as of this time there are only nine cancer diagnoses with available funding.
National Organization for Rare Disorders (NORD): Specifically for patients of rare diseases, NORD helps patients afford life-saving medications. Notably, NORD also offers a Rare Caregiver Respite Program which grants up to $800 annually for the caregivers of patients diagnosed with rare diseases.
To find even more organizations, check out NeedyMeds for a useful list of programs organized by disease or by the patient’s state of residence.
“Extra Help” and State Pharmaceutical Assistance Programs
Medicare members with a prescription drug plan have one more option at their disposal: the appropriately-named “Extra Help” program offered through the Social Security Administration. This program can grant approximately $5,000 a year to eligible patients. The eligibility criteria is somewhat strict, however. Patients must:
- Be receiving Medicare,
- Not be receiving Medicare AND Supplemental Security Income, or Medicare AND Medicaid,
- Live in the 50 states or the District of Columbia,
- And have very limited savings, investments, or real estate.
Completing an Extra Help application will also jumpstart the process for a Medicare Savings Program application. These programs can help cover prescription costs as well.
Finally, patients in certain states may be eligible for specific pharmaceutical assistance programs. The criteria is not consistent, so check for programs in your state, then carefully read the fine print.
What to keep in mind
You will need to do some research to find the best program for your needs. Ask your doctor or pharmacist for help; they may be aware of programs you can use. Medicare.gov has a search tool that sorts through manufacturer and non-profit assistance if you want to really speed up the process.
Once you’re ready to apply, you’ll likely need the following:
- Proof of your current income, such as a tax return,
- Proof of residence,
- A copy of the front and back of your insurance card, if you have one,
- And the assistance of your healthcare provider, who will need to submit information about your prescription.
Most programs will review a fully-completed application (i.e., not missing any information or additional documents) within three business days of receiving it. If approved, patients can expect to receive their award – whether it is a monetary grant or free medication – shortly thereafter. Keep in mind that most assistance is granted for 12 months, after which a patient can reapply for another year of financial help.
We hope that our blog series on cost-savings resources has helped you understand the many ways you can save money on prescriptions. Remember, though: if you can’t afford your prescriptions, we always suggest talking to your doctor or pharmacist first. Ask them to review the medications you are taking. It’s important to ensure they’re appropriate for your current health concerns.