If high costs and high insurance deductibles have you struggling to cover medical costs, an assistance program may help ease the burden. Medication assistance programs, also called patient assistance programs, pay some or all the cost for people in need who meet eligibility requirements.
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Usually run by nonprofit organizations and often supported by pharmaceutical companies, the programs include a wide range of medications and may include other forms of assistance.
Apply for free online to see if you’re eligible
Some programs serve only people without insurance, while others are designed to help pay for expenses not covered by insurance. In many cases, you can apply online, listing income, household size, and your medical condition. Often, you can see right away whether your income is low enough to meet eligibility requirements.
Depending on the program, your doctor will either fill out a form or will be contacted to verify information.
Applying online is free, but scam artists may try to extract their own fees, the Federal Trade Commission and the Partnership for Prescription Assistance warn consumers.1,2
Condition-based assistance programs
Help is often available for people with a specific health condition or those having a certain procedure, such as a joint replacement. In some cases, travel for medical care is covered.
- The Assistance Fund helps people with conditions such as ankylosing spondylitis, juvenile and rheumatoid arthritis, multiple sclerosis, and systemic lupus erythematosus (lupus). The fund helps cover copayments—the amount owed after insurance has paid its share for medication—as well as monthly health insurance premiums. Applicants must meet income criteria and verify that they have been diagnosed with a covered condition. The web address is theassistancefund.org.
- Operation Walk USA provides free knee and hip replacements to uninsured people who do not qualify for government assistance but cannot pay for the surgery. To be eligible, a person must have disabling arthritis of the hip or knee. The joint replacement surgery is done at hospitals across the United States. Visit www.opwalkusa.com.
- Spine Health Foundation, Inc. offers access to surgery and medical-related services for those with spinal injuries and disorders at www.spinehealthfoundation.org. (The foundation is not related to Spine-health.com.) Visit www.spinehealthfoundation.org.
When searching online for a nonprofit assistance program, it’s best to list a specific procedure or condition, such as “assistance paying for discectomy.”
Many medication assistance programs are run by pharmaceutical companies or closely associated with these companies. Help for those with insurance or out-of-pocket costs for people without insurance coverage is typical.
To see what type of help is available from a pharmaceutical program, search by the brand name of a medication, such as “help paying for Ultram” or by the manufacturer’s name.
A good place to start is the Partnership for Prescription Assistance, sponsored by biopharmaceutical research companies. It serves as a clearinghouse for hundreds of public and private programs, including many offered by biopharmaceutical companies. You can contact the partnership by calling 1-888-477-2669 or go online to www.PPARx.org.
These other resources may offer the assistance you need:
- Benefits Checkup, the National Council on Aging website, helps people who are on Medicare and have a limited income sign up for a free program called Medicare Rx Extra Help. The program eliminates or reduces deductibles and premiums to help people pay for prescription medication. The website address is www.benefitscheckup.org.
- NeedyMeds provides information on thousands of assistance programs, low-cost clinics, and more on its website, NeedyMeds.org. Users can list a medication and be directed to a source offering assistance. NeedyMeds also offers a free drug discount card with no income limits or registration required.
- RxAssist offers information on pharmaceutical company programs, state programs, discount cards, and more. After filling in the name of your medication at RxAssist.org, you'll see programs that may be able to help.
- RxOutreach is a nonprofit home delivery pharmacy specializing in affordable medications, at rxoutreach.org. Medications are listed by condition, and you can calculate your eligibility online.
- Certain pharmacies, including both traditional and specialty pharmacies, work with prescription assistance programs on customers’ behalf. Some also offer home delivery.
This is not a comprehensive list. Your doctor or pharmacist may be good resources for additional information on programs that are best for your individual situation.
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- Prescription Assistance Programs: Health Information for Older People. Federal Trade Commission. https://www.consumer.ftc.gov/articles/0319-prescription-assistance-programs-health-information-older-people.
- SCAM Alert. Partnership for Prescription Assistance. www.pparx.org/scam_alert.