Those on low incomes can find it particularly difficult to cope with their prescription drug costs. This can be especially problematic for seniors who, even if they have Medicare Part D, may not be able to afford to pay for essential medicines when they reach the doughnut hole coverage gap.
In some instances, people on low incomes, those without insurance and those who are under-insured may be given help from Patient Assistance Programs (PAPs). What programs are available, how can NeedyMeds help you find free or discounted meds and who is eligible?
What are Patient Assistance Programs?
PAPs are designed to help people with lower incomes access the drugs they need, when they need them. These are generally sponsored and managed by pharmaceutical companies via their own in-house programs. If you are eligible for assistance, you may get free or discounted drugs from the manufacturer. In some instances, you may also find coupons that can save you money or give you access to special deals.
The actual help you are given will vary according to the PAP associated with your medication and its conditions. So, for example, limits may or may not be set on how many days your prescription can cover or whether you get automatic refills or not. Some programs will send your meds to you at home; others will only allow them to be dispensed by your doctor, pharmacist or hospital.
Using NeedyMeds to Find PAPs
You can search through the websites of individual pharmaceutical companies to see what help is on offer. You may, however, find it easier and quicker to use the centralised list of resources on NeedyMeds.org. This 501(c)(3) non-profit information resource provides a list of programs that are searchable by:
- Drug type, including brand name and generics
- Programs
- Companies
- Coupon offers
The site currently contains 4033 medications. It outlines the basics about each drug/program and gives links to relevant websites. You can also get help with an application, including a list of national programs organized by state if you need additional assistance.
Who is Eligible for a Patient Assistance Program?
PAPs share common types of eligibility criteria but they are not all the same and each pharmaceutical company will set its own conditions. Typical requirements include:
- Income: You will generally need to show that you are on a low income although some companies won't use this as a requirement. Low income is usually measured by a Federal Poverty Level calculation (e.g. at or below a percentage of FPL).
- Insurance: Some companies will not accept applications if you have any form of coverage; others may require you not to have an existing prescription plan. In some cases, you will need to be ineligible for other programs (e.g. state and federal assistance) or to be underinsured.
- Part D: Some companies will allow you to apply if you have Part D coverage; others will not or may only accept cases on a hardship basis.
- Residency: Applications may be subject to residency status, although some PAPs do not impose this condition.
- Medical criteria: You may need to have been diagnosed with a specific medical condition to qualify.
If you do not intially meet all the criteria listed for a medication, check to see if it is listed in a different program. It may also still be worth calling the pharmaceutical company to discuss your situation. Some will waive standard requirements in cases of hardship.
Keep in mind that there are other ways for seniors to get help with prescription drug costs such as the Medicare Rx Extra Help program. Looking at generic vs. brand name medications could also help reduce your expenses.
Source:
- NeedyMeds.org, accessed online July 25, 2011.
Carol Finch - Carol Finch is the Topic Editor for Retirement Planning, Budgeting, E-Commerce & Technical/Business Writing on Suite101.
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