Date: October 1st, 2008
For the 47 million Americans without health insurance, each day is a struggle to find a way to pay for prescription drugs. Older adults, who are often prescribed several medications at a time, can find it even more difficult to pay medical bills. Despite the start of Medicare Part D in 2006, the elderly still spend thousands of dollars a year on prescription drug costs. What many people don’t know is that they may be eligible to receive their medications for free.
Patient assistance programs (PAPs) are voluntarily offered by all major drug companies—including, Merck and Pfizer—to provide prescriptions for free, or at reduced prices, to the under- or uninsured. At least 150 drug manufacturers currently provide more than 250 programs for many of the most frequently prescribed drugs.
"I have found enough [patient assistance] programs I financially qualify for to cover $8,500 of my $10,000 annual prescription bill," said Patricia Hewitt in a recent Washington Post article. "That's a lot of dollars." Hewitt, a diabetic suffering from a neurological disorder and gastric reflux disease, and with a history of thyroid cancer, lost her health insurance in 2004 after surviving a diabetic coma in 2001.
Although requirements and eligibility vary, most programs require that patients have incomes below 200% of the Federal Poverty Level, have no prescription coverage, and be U.S. residents or citizens. Many companies don’t offer assistance to patients with Medicare Part D, but patients should check with their providers because some offer it on a case-by-case basis.
There are several ways for patients to learn if programs are available for their medications. They may contact the drug manufacturer directly, visit a number of websites (see below), or receive help from a community program. Once a patient determines that his or her medication is available through a PAP, they can get an application from the company’s website. Some companies require that a patient’s physician receive the application and call to determine the patient’s eligibility first.
Applications commonly ask about the patient’s prescription coverage, veteran status, eligibility for public insurance programs, and income and asset background. Companies may also request proof of income, Medicaid or insurance denial letters, a prescription from the doctor, and patient consent forms. Patients can make the process easier for physicians by filling out the application as thoroughly as possible before returning it to them to complete.
If the company decides that a patient is eligible for a program, the drug will be sent to the patient’s home, pharmacy, or physician’s office—depending on the PAP. The medication may arrive as early as two days, or up to six weeks, after approval. PAPs often offer a limited supply of medications, so patients should learn about the program’s refill or reapplication process.
Other options are available for patients who are denied eligibility for PAPs. A physician or health-care advocate may be able to make an appeal to the manager of the program, explaining why the patient is unable to afford the prescribed medication. Also, drug discount cards allow patients to purchase medications at a reduced price and don’t have such stringent eligibility requirements.
Patients can learn more by hopping aboard the Partnership for Prescription Assistance’s Help is Here Express, a bright orange tour bus that travels to community events across the country to educate people about PAPs. The bus provides wireless computers, cell phones, and assistants to help with the application process.
A number of websites also make the process easier by letting patients search for specific medications and enter eligibility information to determine if they should apply for a PAP. Some applications are also available on the following websites: