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Frequently Asked Questions About Patient Assistance
Programs
What are patient assistance
programs?
Patient assistance programs (PAPs) are programs set up by drug companies
that offer free or low cost drugs to individuals who are unable to pay
for their medication. These programs may also be called indigent drug
programs, charitable drug programs or medication assistance programs.
Most of the best known and most prescribed drugs can be found in these
programs. All of the major drug companies have patient assistance programs,
although every company has different eligibility and application requirements.
Companies offer these programs voluntarily; the government does not require
them to provide free medicine.
How do patient assistance programs
work?
An individual gets an application for the drug company program that has
the medicine the patient needs. Information on medication available through
patient assistance programs and the company programs offering these drugs
may be found on the RxAssist.org. Many application forms are available
on RxAssist.org and can be filled out directly on the computer or printed
out.
Some company programs require that a physician or heath care advocate
(someone working in a physician's office or in a clinic) get the form
by calling the program. Many times in these cases, the patient assistance
program will screen for eligibility before sending out the form. The form
that is sent will have a patient specific identification number on it.
After the form is filled out and submitted to the company, the drug company
will decide whether the patient is eligible to receive the medication
for free. If the patient is eligible, the medication may be sent to the
patient's home, the physician's office or a local pharmacy depending on
the program. Some, but not all, companies send letters letting patients
and/or physicians know whether the patient has been approved for their
patient assistance program.
What are the eligibility requirements
for patient assistance programs?
Eligibility varies program by program. Generally, individuals must have
incomes under 200% of the Federal Poverty Level, cannot have prescription coverage
from any public or private source and must be a U.S. resident or citizen.
Some companies require that the patient has no health insurance.
What do I have to do to
apply for a patient assistance program?
You must follow the directions on the application exactly, answer every
question and include any documents the program asks for. Usually, programs
will ask about prescription coverage, veteran's status, eligibility for
public insurance programs and income and asset information. Companies
also may ask for:
- Proof of income, such as federal income tax statements or pay stubs
- Medicaid or insurance denial letters
- A prescription from your doctor
- Patient consent forms that are included with the application.
Most applications will request information about the physician.
Applications may require the signature of the physician, the patient
or both.
What does my doctor need to
do to help me apply for a patient assistance program?
This depends on the specific patient assistance program. Usually the physician
only has to fill out a few brief questions on the application form and/or
sign it. The physician may also be asked to:
- Call the program for an application
- Write out a prescription
- Include information about the patient's diagnosis on the application
Do I need to pay anything to
participate in a patient assistance program?
Most programs make their medications available for free. A few that
require pharmacy pick-up have up to a $25 co-pay.
How long does it take for my
medicine to arrive?
It can take anywhere from 2 days to 6 weeks for medication to arrive after
approval for participation in the program.
What do I do if I need a medication
refill?
This depends on the program. Some companies require that the physician's
office call to request a refill while others allow the patient to call
directly. Every company has a different policy on how many refills it
will allow.
I have health insurance, but
no prescription insurance; am I eligible for patient assistance programs?
In most cases, the answer is yes. Some companies, however, require that
a patient has no health insurance.
I have coverage for prescriptions
with my health insurance but I have reached my coverage limit. Am I eligible
for patient assistance programs?
Technically, if you have reached your coverage limit you no longer have
prescription coverage, but we suggest attaching a letter with your application
that indicates this. If you have a letter from your insurer stating that
you have used up your benefits, send that along as well.
I have Medicare Part D. Do I qualify
for these programs?
This will vary depending on the particular patient assistance program that carries your medication and that company's policy. In general, companies do not allow Part D enrollees who are eligible to receive the full low income subsidy (LIS or extra help) to apply for their programs. If you have Part D, it is a good idea to get a letter from Social Security indicating that you are not eligible for the low income subsidy.
Although RxAssist does it's best to keep it's information as current as possible, companies can and do make changes without notice. Companies may also be willing to review cases on a case by case basis, where financial hardship is involved. It always makes sense to call the program to check on it's policy.
Click here to see a chart of PAP's and their Medicare Part D policies
What
do I do if the company decides that I do not qualify for its patient assistance
program?
It is up to each company to decide who can have medication for free and
who cannot. For a variety of reasons, some patients are turned down for
these programs. In that case, the best thing to do is ask your physician
or health care advocate to make an appeal directly to the manager of the
patient assistance program that explains exactly why you cannot afford
to buy your medication. We suggest a letter followed by a phone call.
Click here for an example of an appeal letter to a patient assistance
program.
Are
there patient assistance programs for generic medications?
Yes. Both Rx Outreach and Xubex
Pharmaceutical Services offer patient assistance programs for generic
drugs. These programs differ from all other patient assistance programs
in that they are not offered by the pharmaceutical manufacturer of the
drug. They are programs that include several different generic drugs which
are purchased by the company and then made available for a fee to low
income individuals. Both companies have income requirements to be eligible
and both charge a fee to receive the medication. Xubex charges shipping
and handling as well.
Use our database to determine if your medication is available in one of these programs.
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