What are Patient Assistance Programs?
Commonly referred to as PAPs, Patient Assistance Programs are services offered by pharmaceutical companies for those who cannot afford their medication. Patient assistance programs are available to low-income individuals or families who are under-insured or uninsured and are provided to those who meet the eligibility guidelines. Assistance may range from reduced cost of drugs to free medicine. Each drug that a company offers will have its own unique program and may even have a different eligibility requirement than the other drugs they offer. As there is no unified standard of designation for these programs, you may also see them referred to as medication assistance programs, indigent drug programs, and charitable drug programs.
Patient Assistance Programs are not mandated or managed by the federal government and are offered as a free service by the pharmaceutical industry. Nearly all of the major pharmaceutical companies provide specific programs for their most popular drugs. As each program is different, please take a look through our comprehensive database which allows you to search by drug or company name to find your medicines specific patient assistance program. Each profile will provide you with detailed information on how their specific program can assist you with your medication bill and what requirements are needed to qualify for assistance.
Are there general eligibility requirements?
After properly identifying the pharmaceutical company who offers the medicine you would like assistance with, you can begin the the enrollment process. The initial enrollment form along with detailed company information and eligibility requirements are listed in each profile in our database.
Select the enrollment form from the right side of the profile and proceed to either fill it out online or print a hard copy to fill out manually. You should always keep record of the form you have submitted, including the date.
If the form is not available for the medicine you have selected, that indicates either the company only distributes their form through regular mail or they require contact from your primary care physician before providing the form. Contacting your physician allows the company to screen for eligibility before the claim is submitted.
Once the company receives your enrollment form, they will review your eligibility. If you qualify, they will provide you the medication by sending it to your mailing address, your physicians office, or a local pharmacy. If you do not qualify, many companies will not provide you any response to your submitted form.
What steps do you need to take?
Yes. Although eligibility differs from program to program, they all have three specific criteria in common.
Income: To qualify for any patient assistance program, your total household income must be less than 200% of the Federal Poverty Level.
Prescription Coverage: Prescription assistance programs require that you do not currently subscribe to private or public sources of prescription coverage.
Residence: You must be a United States resident or citizen to be eligible for any of these programs.
You should check each companies profile before assuming that they do not request additional information for eligibility. Many companies only require the three criteria listed above to verify eligibility in their programs.
What other material will I need to provide besides the enrollment form?
Many pharmaceutical companies will require additional material to be submitted along with your completed enrollment form. As stated before, there are no unified guidelines for what each company requests, but you can expect that many of them will require similar information. Below you will find a list of the information most commonly requested by patient assistance programs.
Income: Many companies will request that you provide proof of income. The following are examples of acceptable material to submit for this request: Federal or State tax statements, pay stubs, or bank statements.
Coverage: As the general eligibility guidelines exclude applicants currently enrolled in prescription coverage programs, you may be required to provide insurance related information. The following are examples of acceptable material to submit for this request: current insurance plan statement, a rejection letter from Medicaid, or a rejection letter from an insurance company.
Physician Related: It may be required that your physician provide additional information besides what was requested on the enrollment form. Your physician may be requested to provide: a prescription for the specific medication, doctors information, or their signature.
Each company may request specific material from you in addition to your enrollment form. Please take the time to review each companies profile in our database before you submit your finished application.
What is required of my physician during the enrollment process?
While they're are some enrollment processes that do not require interaction from your physician; many request that they provide answers to question on the form or directly sign it. Each patient assistance program enrollment will detail what information they will need from your physician. As stated before, there are no unified guidelines for what each company requests, however you can expect that many will require similar information. Below you will find a list of the information most commonly requested from your physician.
Patient Diagnosis: Required in the same manor as an insurance company requests when authorizing medication for a patient. The diagnosis is used to determine if the specific medicine in question is the best option for the patient.
Prescription: In any situation that medication will be supplied to a patient, a prescription from their physician is necessary. Enrollment processes that ask for this information will require the patient/physician to attach the prescription to the form or provide the prescription to the pharmacy where the medication will be received.
Some enrollment forms can only be acquired by having the physician contact the pharmaceutical company directly. By making contact with your physician, the company can determine eligibility before the form has been submitted. Please see the profile for the patient assistance program you're inquiring about for further details on what is required from your physician.
Is there any cost associated with patient assistance programs?
In most cases, there is no cost associated with patient assistance programs. If there are any costs for the program, it will be displayed in the profile for the pharmaceutical company whose medication you are inquiring about. Many PAP's provide their medication completely free or at a significant discount off the uninsured cost. If you acquire your medication through a local pharmacy, you may be charged up to a $25 co-pay. This is not imposed by the pharmaceutical company, but by the pharmacy you are working with.
When should I expect to receive my medication?
After your enrollment application has been accepted to the patient assistance program, it may take up to 6 weeks before you start receiving your medication. If the enrollment form stated that your medicine will be sent to the nearest pharmacy or your doctors office, it is recommenced that you provide them with your most recent contact information so they can inform you that your medication has arrived.
Please note: It is not guaranteed that you will be contacted if your enrollment form has been rejected. Make sure to save information detailed by the pharmaceutical company on how to check the status of your application.
How are refills handled?
To request a refill, you or your physician will have to contact the pharmaceutical company. Who contacts the company is dependent on the requirements of the PAP that you have enrolled in. Please keep in mind that you may only request a refill during your enrollment period. Each program will clearly state how often you need to resubmit your application. Failure to do so will result in a termination of the provided services and a rejection of your refill request. As each program is different, please refer to your patient assistance program's profile in our database for information regarding the refill process and enrollment duration.
Does having health insurance disqualify me from eligibility?
While belonging to a prescription coverage program renders you ineligible for any patient assistance program, it is not universal as to whether having health insurance will do the same. Although having health insurance will not effect most patient assistance programs, some do require that you do not have any form of public or private coverage. The company profiles within our database will provide you with the eligibility requirements for the specific PAP you are inquiring about, including their requirements regarding health insurance.
Am I still eligible if I have used all of my current prescription coverage?
Once you have used all of your prescription coverage, you are no longer considered covered as it provides you no use. It is recommended that you wait until you have received documentation stating that your prescription coverage plan has been exceeded before you submit your application for enrollment. Even though many patient assistance programs will not require it, you should provide a copy of that statement along with your enrollment application to prevent an accidental disqualification.
Will having Medicare Part D disqualify me?
Most patient assistance programs disqualify all those eligible for the full low income subsidy through Medicare Part D. If you do not qualify for the full low income subsidy, you should attach documentation from Social Security stating that you are ineligible, to your enrollment form. Please keep in mind that this information varies greatly between different companies and is subject to change without notice. If the profile for the patient assistance program in our database states that you are disqualified for having Medicare Part D, it is recommended that you contact the company directly to request your case be further reviewed. It is not uncommon for exceptions to be made for those facing financial difficulties.
Why has my enrollment been disqualified and what can I do about it?
Unfortunately not every enrollment application to a patient assistance program will be accepted. As these services are provided for free by the pharmaceutical companies, it is at their discretion who they reject and for what reason. It is unlikely that you will be disqualified for anything other than failing to meet all eligibility requirements.
It is possible to have the rejection overturned by submitting your application for appeal. You should request that your physician provide you with a letter of detailing under what circumstances your case should be reconsidered. After making copies of the material for your own record, send a fresh copy of your application, rejected application, and your physicians letter to the address listed for the patient assistance program with "ATTN: Appeals Department" on the front of the envelope.
