A new prescription can result in a case of sticker shock, even if you have health insurance. High prices don’t mean you have to go without the medications you need. If you can’t afford them, you’ll be happy to hear that many organizations and most pharmaceutical companies have patient assistance programs.
How Patient Assistance Programs Work
Some programs help people who lack health insurance. Others are targeted toward people who have insurance, but their medications aren’t covered or their copays are too burdensome. Each patient assistance program has its own set of rules and eligibility requirements. These often include proof of income, health insurance documents, and information from your prescribing doctor.
If you’re accepted, your medications may be shipped to your home or to your doctor or hospital (where they’ll be administered). Funding may be for a limited supply or periodic refills. Some programs require a new application each year. You can apply to more than one program, so it’s worth pursuing all available avenues.
Patient Assistance Program Guides
Now that you know there are assistance programs out there, how do you find the right one? The volume of programs may seem overwhelming. Fortunately, there are several free guides designed to help cut through the clutter and narrow down your choices. If you don’t find your medication in one database, it just may show up in another, so don’t give up.
If you’re having trouble paying for medications, the nonprofit organization NeedyMeds can help you find the information you need. Its database includes information on more than 5,000 assistance programs and drug discount coupons. The website is easy to navigate. Simply type in the name of the medication you need. You’ll get program details and a link to the program website. If you need assistance, call the toll-free helpline at 1-800-503-6897.
Partnership for Prescription Assistance (PPA)
The Partnership for Prescription Assistance provides information and links to programs that can help you get your medications for free or at reduced prices. The “medications wizard” will help you search for your medication by name. By answering a few more questions, you’ll get a list of programs, eligibility requirements, and contact information.
You can submit your application directly to the assistance program you want. The database includes more than 475 programs offered by almost 200 biopharmaceutical companies. Call 1-888-4PPA-NOW to speak with a trained specialist.
RxAssist is another nonprofit information center with a searchable database of patient assistance programs. First, type in the name of your medication. Within seconds you’ll have a comprehensive list of available programs, eligibility details, and instructions on how to apply. There’s also an alphabetical patient assistance program directory.
Specialist Patient Assistance Programs
Some organizations provide assistance for a particular range of conditions or drugs. Rules and eligibility requirements vary. It’s worth your time to research some of these options.
Chronic Disease Fund (CDF)
The CDF offers copay assistance to people who have health insurance but still can’t afford their medications. The nonprofit covers only FDA-approved drugs for specific conditions, which are listed on the website.
If your medication is covered, you can fill out an online application. You’ll have to provide information about your diagnosis and your household income. You’ll also be asked for contact information for your insurance carrier and your physician.
The great thing about the CDF is that you won’t spend a lot of time in limbo. Applications are processed within a day. If you’re not approved, they’ll direct you to other resources. You can reach the CDF at 1-877-968-7233.
National Organization for Rare Disorders (NORD)
If you’re uninsured or underinsured, NORD’s medication assistance program might be able to help you pay for prescription drugs. The nonprofit lists medications and disease-specific assistance programs, along with the contact information you need to get started. If your medication isn’t one of those covered, NORD provides a list of other programs that may help.
Patient Access Network (PAN)
The PAN website has a list of the drugs covered under this program. To be eligible, you must have health insurance that covers the medication you need. Also, the medication must directly treat the disease for which you’ve been diagnosed. Income level requirements vary, depending on the disease-specific program. Your online application will result in an immediate response from this nonprofit organization. You can reach a case manager at 1-866-316-7263 if you have questions.
Patient Advocate Foundation (PAF)
The PAF is a nonprofit providing copay relief for specific conditions listed on the website. You must have an insurance policy or a Medicare part D policy that covers the medication you need. Your income can’t exceed four times the Federal poverty guidelines.
You can apply online, or your doctor or pharmacy can do it for you. A copay relief representative can be reached at 1-866-512-3861.
Medicare Prescription Drug Program
The Medicare prescription drug program doesn’t help with specific drugs or conditions. But this government program assists with deductibles, copays, and premiums associated with the Medicare prescription drug program.
The application for assistance includes disclosure of your net worth. This can be a tough number to figure out. Save yourself some time and trouble by hitting the website’s “find out if you qualify” button before filling out an application. If you need assistance, call 1-800-772-1213.
Pharmacies and Drug Discount Cards
Some wholesale and retail chains have discount pharmacy programs, and many offer low prices on generic medications. These include:
- Costco wholesale member prescription program
- Kmart prescription savings program
- Sam's Club plus member pharmacy discount
- Target pharmacy
- Walmart pharmacy services & savings program
Check with your favorite retail chain pharmacy to see if they offer a discount program.
Some associations and organizations, such as AARP, provide discount drug cards that can reduce your costs. When looking at this option, you’ll want to compare all the associated fees with your potential for savings.
Some things to consider include:
- Is there a monthly or annual fee for the card?
- If membership in an organization is required, what is the fee to join? What is the annual fee?
- What medications are included or excluded?
- How much is the discount?
- Are there restrictions on the pharmacies you can use?
- Are there yearly caps?
- Are you dealing with a reputable organization that’s easy to contact?
Prescription medications can be expensive, but there’s a good chance you can find a program to ease the burden.