Healthcare is prohibitively expensive, especially for low-income Americans. 28.1 million Americans lacked health insurance in the first three months of 2017. There are millions more who have inadequate coverage. Unfortunately, many Americans just can’t afford healthcare, and even if they can, many lack funds for the prescription medicine they need.
Fortunately, several patient assistance programs can help you cover the cost of your family’s prescription medication.
What Are Patient Assistance Programs?
Patient Assistance Programs (PAPs), sometimes also called Prescription Assistance Programs and Medication Assistance Programs, help people without health insurance or prescription drug coverage obtain the medications they need, but cannot afford. These programs are offered by state governments, non-profit organizations, and even individual pharmaceutical companies!
All these agencies understand that some people cannot afford the drugs they need to stay healthy. They are willing to put people over profit to honor their patient-centered principles.
Links to programs listed here can be found at the end of this article.
Who is Eligible for PAPs?
The eligibility criteria and application process for PAPs vary from program to program, and you should look into which program might best suit your circumstances. There are some general requirements for every applicant:
They must be a US citizen or legal resident
Have limited or no prescription coverage
Meet program income guidelines
Each program will have criteria beyond these. If you need a specific drug, look for the PAP search link at the end of this article and type in the drug name.
Are PAP Applications Free?
Patients do not need to pay a fee to file a PAP application or have their application reviewed. Some organizations will help you with the application process and might charge you a fee for doing so. You should understand that you can complete the application on your own and you do not need to rely on any third-party companies to do so for you. Be a smart consumer, and avoid scams!
It’s important to note that all PAP applications require a doctor’s signature and some may ask for your medical and financial information as well.
Once your application is approved, your medications will probably be sent to your doctor’s office for you to pick up. In other circumstances, the medications may be sent to a pharmacy for distribution, and you might receive a certificate to present to your pharmacist to retrieve them.
Medicare Part D
Medicare Part D (also called the Medicare prescription drug benefit) is a federal government program that subsidizes the cost of prescription drugs for eligible Medicare beneficiaries. Anyone on Medicare is entitled to Medicare Part D regardless of their income. No physical examinations are required, and nobody can be denied for health reasons or because they already take a lot of prescription medication.
While Medicare Part D is optional, and Medicare beneficiaries do not automatically receive Part D coverage, you shouldn’t hesitate to apply for this valuable benefit! Even if you do not currently take any prescription drugs, Medicare Part D is still a valuable program that can protect you should the need suddenly arise. You may incur a late-enrollment penalty if you delay signing up to the last minute, so think ahead and protect yourself.
You can find out more about Medicare Part D on the official Medicare.gov website.
PAPs and Medicare Part D
Some drug companies allow Medicare Part D recipients to apply for their PAPs, and any assistance they provide won’t count towards the Part D beneficiary’s true-out-of-pocket cost (TrOOP).
However, these PAP programs assess applications on a case-by-case basis. Check their terms and conditions and make sure that you fit their eligibility criteria before you apply. It’s also a good idea to explore plenty of alternatives, so you aren’t pinning all your hopes on just one possible option.
State Patient Assistance Programs
Many states offer State Pharmaceutical Assistance Programs (SPAPs) to help their residents with the cost of prescription drugs. While most coordinate their programs with Medicare Part D, each program works differently. That’s why you should inquire specifically about your own state’s offerings and eligibility criteria.
For more information about SPAPs, including whether your state has one, how it works, whether you are eligible, and how to enroll, select your state from the drop-down box on the State Pharmaceutical Assistance Page on the Medicare.gov website.
Patient Assistance Programs Run By Non-Profit Organizations
Many PAPs are run by pharmaceutical companies, but several non-profit organizations offer valuable information, news, and comprehensive databases to help patients find the best programs for them. These non-profit organizations aim to increase awareness of PAPs and get more eligible individuals to enroll in them.
Here are some of the main ones:
The Partnership for Prescription Assistance (PPA) is sponsored by America’s biopharmaceutical research companies. Working with doctors, pharmacists, and other healthcare providers, as well as patient advocacy organizations and community groups, PPA has helped more than 10 million people access public and private patient assistance programs since its launch in April 2005. The PPA website, linked above, allows patients to search the name of a prescription drug or their address/zip code, to get the most accessible medication for them.
The RxAssist.org website provides information for both healthcare providers and patients alike. It features a comprehensive database that can be searched using either the name of a prescription drug, the company that produces it, or a medical brand name.
There are also some useful resources relating to PAPs, including a Patient Savings Center.
RxHope.com is similar in both name and functionality to RxAssist. This website offers information and help to people who are having trouble affording their vital medication. Rhone provides free online patient assistance along with its medication search option.
RxOutreach sounds similar to the previous two entities but is a non-profit pharmacy whose mission is to provide access to affordable prescription drugs. Eligible patients can enroll and find medication on the RxOutreach website.
NeedyMeds maintains an extensive database of information about patient assistance programs, drug discount programs, and free or low-cost medical care on its website. The database search facility is free, and patients can even get help with the application process for the numerous PAPs that are out there.
The National Council on Aging‘s (NCOA) Center for Benefits is not specifically dedicated to providing information on PAPs. However, it does contain lots of useful medical guidance for low-income seniors and young people with disabilities, including the best nonprofit and government benefit options to help them pay for their medication.
As you can see, plenty of programs and initiatives can help you shoulder the cost of your medication. Just be sure to check which ones you are eligible for and which ones provide coverage for the specific medications you are taking. If you’re taking a lot of medicines and feeling the financial strain, take advantage of the free application help that drug companies, non-profits, and state governments generously supply. And above all else, remember to have hope. With hope in your heart and knowledge of the best healthcare resources in your mind, you can survive both health and financial woes!
Drug Company PAP Search
Medicare Part D
State Patient Assistance Programs
Partnership For Prescription Assistance
National Council on Aging (NCOA) Center for Benefits