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Patient Assistance Programs
Is there really such a thing as "free drugs"?
Yes! Pharmaceutical companies realize that not all American
residents have the
resources to pay for necessary medication. In fact about 1 in 5 have no
insurance and even more are underinsured. Making a person choose
between food or prescriptions isn't fair, so the pharmaceutical
companies are trying to help. These programs sponsored by the drug
companies are typically called "Patient Assistance Programs" or PAPs.
Most companies have PAPs available for their newest and most expensive
drugs. Medications that have been around a long time and are made
by many manufacturers usually don't have a program available.
But are these "free medicine" programs really FREE?
Yes!
Most drug companies will send the medication for a patient free of
charge. In a few situations, the patient may be asked to pay a
small co-pay, but this is not the usual practice. For the majority
of the medications you will complete an application, provide valid
income documentation, mail it in and then receive the medication free, the cost
being only your time and postage.
However you will find there are services available that will assist
you in getting and completing the applications. While you can research
the internet and find the applications for free, it is also not
unreasonable to expect to pay a small fee for a service to help you.
The choice is yours, however it is not recommended you pay more than $20
per month or $5 per application for such assistance.
How do these patient assistance programs work?
These programs are really quite simple, however they do take time to
become enrolled and you need to follow the company guidelines
explicitly. The general process is as follows.
Your doctor prescribes you a new prescription, something you find is
quite expensive at the pharmacy.
You do your research and find the drug manufacturer has a PAP for
this medication. You obtain an application, look at it's specific
criteria, and if you match, you fill out and sign the application.
You then have your doctor sign the application and sometimes provide
a new prescription as well.
You send this to the drug manufacturer. They take 2-6 weeks to
decide if you qualify for the free medication program. If you are
not approved, they should send you or your doctor a letter, If you
are approved, they will send the medication either to your doctor or to
your home - depending on their specific policy. You will need to
make sure your doctor is aware they'll need to call you if it is shipped
to their office. Usually 3 months supply of medicine is shipped at one
time.
How do I know if I qualify for free medicine?
Specific details will vary from drug company to drug company, but
there are general guidelines most follow.
1. In most cases the patient must be a United States resident and
citizen. There are a few companies that will accept a green card.
2. Patient must not have any prescription insurance.
This includes any drug benefit from state or federal programs or
private insurances. Again, there are a few exceptions, but that is
the general rule. It never hurts to ask a drug company if you can
qualify if you have a unique situation such as insurance denial for a
necessary drug.
3. Patient must fall within certain income limits.
This varies widely between the companies, but generally speaking the
maximum income is around 200% of the Federal Poverty Level. (see chart
below). Some companies are as low as 185%, some much higher.
Again, if the application doesn't specify it doesn't hurt to ask for
help. Remember, this income must be verified with submitted
documentation.
I think I qualify, what are the step by step instructions to get my free prescriptions?
1.Make a list of all the medications you take, or at least the
ones you want to find assistance for. You then need to find the
manufacturer of these medications. If you don't know it, one way
is to get the free list on the left side of this page.
It is a list of over 700 medications by brand name and drug
company.
2. Contact the drug company to find out information on their Patient
Assistance Programs. They may be able to direct you to their website,
fax you an application, or mail one out to you. You can search the
internet for fee-based programs to help you (Search "free drugs") or try needymeds.com
3. Complete the patient information part of the application. Leave No
Blanks! Be sure and sign it everywhere it asks for "patient
signature".
4. Take application to your doctors office for his/her signature (if
required- and most do). Be sure to talk to the office staff about
calling you if your medicines are shipped there instead of your home.
Have doctor give you new, original prescription if required by company
(many do require this). Make sure the prescription is for BRAND name only! Very Important -
many companies will reject a prescription written for a generic name.
Most doctors are more than willing to do this to
ensure their patients get the meds they need. In fact, some clinics
have staff devoted to just filling out patient assistance forms! Ask at
your doctors to see if they do, they can help save you a lot of time.
If your doctor rejects the idea of signing your
application, you may want to ask the doctors nurse or assistant
separately to see if he/she may be able to persuade the doctor to sign
it. It is unlikely a physician will outright refuse to do this.
5. Review entire application, including the physician information.
Make sure no information is missing from any part of the
application.
6. Gather required income documentation. All companies will
require this. The 2 most acceptable forms are either last years 1040 or
a copy of Social Security check/awards letter. For more types of
documentation
click here
Please try to be sure you fit the manufacturer
guideline for income limit before applying, although it doesn't hurt to
try if you're not sure. While many companies don't disclose their
specific limits, the Federal Poverty chart at the bottom of the page is
a general guideline for many companies. .
Whatever
number you write on the application, be sure you have the documentation
to back it up. In other words, write the exact same amount as your
document says. For example, if your SSDI check is $697.25 per month,
write $697.25 on the application, do NOT write $697, $698 or $700. It
must match EXACTLY or it will likely get rejected.
7. Some companies require a letter of denial from your state medicaid
organization. Be prepared to supply this, though only very few ask for
this. Another form a few companies require is a letter of
termination from your last insurance company. Just be sure you find out
if this is the case for the drug you are requesting so you can be
prepared.
8. COPY EVERYTHING! Sometimes things get lost - be prepared so
you can quickly send again. Having this also helps in the refill
process.
9. Double check you have all requested information such as income
verification, prescriptions and all other documentation.
10. Fax or Mail it in! Faxes are processed faster, but
many companies will not accept faxes. Look at a specific company's
requirements and submit accordingly. NOTE that there are a few companies
that require your doctors office to contact them. If this is the
case, make it VERY EASY for the office staff to do this. Provide
all information you've gathered above to give to the office. Some
companies that require this are GlaxoSmithKline, Roche and Astellas. As
stated earlier, call and get the required information so your doctors
office can easily call them.
11. Check back with the patient assistance program if you have
not heard from them for 2 to 3 weeks. There may be missing
information or they may not have received your application. If
they haven't made a decision yet, they'll tell you and you can check
back accordingly. It is up to you, the patient, to stay on
top of this process - after all, you want your medication as soon
as possible, right?
12. If you are denied be sure to find out exactly why,
and begin the reapplication process accordingly. If your income is
too high, there is probably nothing you can do about it unless your
income changes. If it was simply an application error be sure to fix it
and reapply.
13. Once you are approved and receive your medications,
find out what the refill process is. Many programs require you or
your doctor to call every 3 months to have the next prescription
shipped. If this is the case, mark it on your calendar 3 weeks
before it is due so you don't forget to call. All companies will require
new applications with documentation at least yearly, some every 3 months
and some every 6 months. If your medication manufacturer requires
it every 3 to 6 months, see if you can make it easier on your doctor to
sign 1 years worth of applications at one time so you can easily send it
in when it is due.
Now is a good time to mention the vials you receive
may be stock bottles from the manufacturer, or it may be labeled with a
pharmacy prescription label just like you pick up at the drug store.
Either way, make sure you understand how to take it from your doctor.
VERY IMPORTANT TO REMEMBER WHEN YOU COMPLETE THE APPLICATION FOR YOUR FREE
MEDICINE:
Fill out EVERY line on the
application! Your application may be rejected for very simple
reasons-even just missing a date! So put SOMETHING on every line !
If it doesn't apply to you, put N/A, None or "0" as applicable. If
you don't the drug company won't know if you forgot to fill it out or if
it doesn't apply and they'll likely reject it - Don't take the chance!
FEDERAL POVERTY TABLE FOR 2008
The federal poverty level changes for year to year, and it is
slightly higher for residents of Alaska and Hawaii.
Household size represents how many people are living together are
supporting each other. If there are 2 working parents and 3
non-working children, household size is 5 and income from both parents
must be considered. If there is only one person with income and 3
dependants, household size is 4.
The percent is based on the actually poverty level. 100% FPL is
what the US government has established as standard poverty. 200%
FPL is 2 x that amount, and is what most drug companies use as their
income limit. 250% is also included. If a company
says their income limit is 250% FPL, than household income must be AT or
BELOW that amount.
| Family Size |
100% |
133% |
150% |
200% |
250% |
300% |
| 1 |
$10,400 |
$13,832 |
$15,600
|
$20,800 |
$26,000 |
$31,200 |
| 2 |
$14,000 |
$18,620 |
$21,000 |
$28,000 |
$35,000 |
$42,000 |
| 3 |
$17,600 |
$23,408 |
$26,400 |
$35,200 |
$44,000 |
$52,800 |
| 4 |
$21,200 |
$28,196 |
$31,800 |
$42,400 |
$53,000 |
$63,600 |
| 5 |
$24,800 |
$32,984 |
$37,200 |
$49,600 |
$62,000 |
$74,400 |
| 6 |
$28,400 |
$37,772 |
$42,600 |
$56,800 |
$71,000 |
$85,200 |
| 7 |
$32,000 |
$42,560 |
$48,000 |
$64,000 |
$80,000 |
$96,000 |
| 8 |
$35,600 |
$47,348 |
$53,400 |
$71,200 |
$89,000 |
$106,800 |
| For each
additional family member |
$3,600 |
$4,788 |
$5,400 |
$7,200 |
$9,000 |
$10,800 |
More Questions? Please see the list of
Frequently Asked Questions
.
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ATTENTION CLINICS AND PHYSICIANS:
Does your office need help managing your patient assistance programs? Email
SeattleRxAdvocate@
gmail.com
for
information on consultant services
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