As a specialty pharmacy provider, we review the patient’s reimbursement situation and offer financial assistance options to those on high-cost medications.
We help connect each patient with assistance solutions for affordable treatment options.
Copayment Assistance Programs:
- Also called a manufacturer copay card, may be available to patients who have prescription insurance.
- May be offered in the form of a rebate, coupon, or copayment card directly from the manufacturer.
- Manufacturer programs are typically offered to all patients, are not usually need based, and do not usually require an application process.
- Policies on whether or not these programs can be used in conjunction with a patient’s government-sponsored plan vary, and most do not include patients who receive Medicare, Medicaid, or Tricare.
Company-Specific Patient Assistance Programs:
- Patient Assistance Programs (PAPs) are programs set up voluntarily by pharmaceutical companies to offer free or low-cost drugs to primarily uninsured patients who cannot afford their medication.
- Each program has its own rules, patients must typically be US residents, have no prescription insurance, and be under 200% of the federal poverty level as certified by the physician or required documentation.
- Companies vary on whether or not they allow Medicare and other government-insured patients to enroll in these programs.
Disease-Based Patient Assistance Programs:
- Funds are usually administered through a not-for-profit group that can evaluate a patient application based on financial need.
- Funds and foundations typically deal with medications and diseases that are expected to have significant out-of-pocket expenses (often thousands of dollars per month) associated with them.
- Programs can assist patients who are having a difficult time paying for the deductible, coinsurance, or copayments.
- Pharmaceutical companies often fund these programs, but are not involved in evaluating whether or not the patient meets the pre-specified program requirements.