Guide to Managing Medical Bills
Source: Triage Cancer
Cancer is expensive. But knowing some key tips on how to manage your medical bills can help you avoid unnecessary expenses. This Guide will cover some ways to reduce your costs before you get medical care and after. The most effective way to avoid high medical bills is to make sure that you have adequate health insurance coverage that covers your healthcare providers and your prescription drugs.
To better understand health insurance terms and how to pick a health insurance plan, read our Quick Guide to Health Insurance Basics (https://triagecancer.org/quickguide-healthinsurancebasics) or watch these animated videos:
Health Insurance Basics https://triagecancer.org/video-HealthInsuranceBasics and
How to Pick a Plan https://triagecancer.org/video-pickingaplan.
Ways to Avoid Higher Medical Bills Before Care
While it is impossible to completely avoid out-of-pocket medical costs related to a cancer diagnosis, you can take steps to avoid higher-than-necessary medical bills.
- Have the Right Insurance. People tend to only look at a plan’s monthly cost when choosing a health insurance policy. You should also look at the out-of-pockets costs that you have to pay when you get medical care, such as co-payments, deductibles, and out-of-pocket maximums. You also need to make sure the plan covers your providers, hospitals, and prescription drugs. Reviewing your health insurance coverage is something that you should do each year to make sure that you have the coverage that is best for you. For tips on how to do this, visit https://TriageCancer.org/HealthInsurance.
- Discuss Costs With Your Health Care Team Before Treatment. Your health care team may have suggestions for reducing costs … for example, arranging healthcare appointments grouped together, helping you avoid extra co-payments for office visits.
- Get Necessary Pre-authorizations. Many health insurance companies require you to obtain prior approval (also called pre-authorization, prior-authorization, or pre-certification) before you get medical care. If you don’t get the pre-authorization, your health insurance company might deny your claim. Make sure your healthcare team contacts your health insurance company before treatments, testing, surgery, or hospitalization to check if you need a pre-authorization. If your healthcare team does not request pre-authorizations for you, you are responsible for getting approval from your insurance company. Also, even if you receive approval, it does not guarantee that your insurance will cover your care.
- Go to In-Network Providers When Possible. To be a part of a plan’s network, doctors and facilities contract with the plan and agree to accept a specific rate for their services under the plan. These doctors and facilities are considered “in-network.” Doctors and facilities that do not have a contracted relationship with an insurer are considered “out-of-network.” Some Preferred Provider Organization (PPO) plans have limited coverage for out-of-network providers (eg, 50%). Most Health Maintenance Organization (HMO) and Exclusive Provider Organization (EPO) plans pay 0% for out-of-network providers.
- Make Sure Health Care Providers Have Up-to-Date Information. Make sure that all of your healthcare providers have your current contact and insurance. Take your insurance cards with you to each medical appointment and to the pharmacy.
- Be a Good Consumer. Consider your healthcare options like you would any other item or service you purchase: shop around and compare prices. For example, you usually don’t have to use a specific lab for a blood test. Not all labs charge the same amount, and there can be a significant difference in your cost if the lab is not in your health insurance plan’s network. For more information on ways to shop for medical care, visit the Managing Finances module at https://TriageCancer.org/Cancer-Finances.
- Negotiate With Health Care Providers. If shopping around for lower cost providers is not an option, you might be able to negotiate your medical bill, before you get care. Ask for up-front pricing for all non-emergency tests and procedures and ask if there are any discounts available. For instance, providers may offer a discount for paying in cash rather than by credit card. You might qualify for an “ability to pay” program or “charity care” at a healthcare facility. Many hospitals have a billing department and even patient navigators who can help you negotiate a bill.
- Keep Track of Your Out-of-Pocket Maximum. While your insurance company usually keeps track of what you have paid for medical care out-of-pocket, and may even list that on each Explanation of Benefits (EOB) that you receive, it can be helpful to keep track on your own to make sure those amounts match. Mistakes happen and you don’t want to pay more than you are required to under your plan.
- When you visit a provider, you may be asked to pay a co-payment when you check in. If you have an insurance plan that includes your co-payments in your out-of-pocket maximum, your provider may not know that you have already reached your out-of-pocket maximum and, are not responsible for paying any more co-payments for the rest of your plan year.
- Leverage Out-of-Pocket Maximums. If you reached your maximum for the year, consider addressing any other healthcare needs you have, rather than waiting until the new plan year, where you will have to meet your out-of-pocket maximum again.
Understanding Balance Billing and Surprise Billing
Be Aware of Balance Billing. Balance billing occurs when out-of-network doctors and hospitals bill patients for the difference between a billed charge and a health insurance plan’s allowed amount. For example, if you choose to see an out-of-network provider and that provider charges you $100 for a service, and your health plan pays only 50% for out-of-network care, then that provider can bill you for the $50 balance.However, this type of balance billing is typically not allowed if:
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- You have Medicare and use a health care provider who accepts Medicare
- You have Medicaid and use a health care provider who has an agreement with Medicaid
- Your doctors or facilities have a contract with your health plan (in-network) and are billing you more than the plan’s contract allow.
Be Aware of Surprise Billing. You might face a surprise medical bill when you receive care from a provider you did not know was out-of-network. For example, you schedule a surgery with a surgeon and hospital that are in-network, but after your surgery, you find out that the anesthesiologist was not in-network when you get a large surprise bill from the anesthesiologist. Some states have tried to protect patients from balance billing: http://triagecancer.org/statelaws.
Communications Around Medical Bills
The amount of paperwork generated each time you receive medical care can be overwhelming. Each time you get medical care, you can expect to receive some, or all, of the following items in the mail, by e-mail, or posted in your online insurance account, or online electronic medical record offered by your provider.
From the health insurance company, you may get:
A letter indicating it has received a claim from the health care provider
A letter saying it is processing the claim
An explanation of benefits (EOB), which details the claim received, how much the provider charged for the particular service (eg, an X-ray), what the health insurance company is going to pay the provider, and what the patient may owe the provider (often called the “patient responsibility”). Generally, EOBs are identified by the statement “THIS IS NOT A BILL” somewhere on the page
From the health care provider:
The bill with an amount that the patient is responsible for paying
Wait to send in a payment to your provider until you receive your insurance EOB to ensure that the bill and the EOB match and that they are correct. If you are concerned about missing the due date on the bill while waiting for your EOB, contact your provider and let them know that you are waiting for your EOB.
Reviewing Your Medical Bills
Once you’ve gotten a medical bill, it’s important to review it to make sure it is accurate. Don’t be afraid to ask your providers to explain codes or descriptions of services you received. You should look for:
- Small errors, like a wrong number or code, can make a big difference in your bill. Ask for an itemized list of charges, request a copy of your medical records and pharmacy ledgers, and check that everything matches up.
- You might be able to challenge certain charges, such as:
- Procedures that were ordered and then cancelled
- Medication ordered for you but never given to you
- Hospital errors (e.g, lab results were lost so the test had to be redone)
- Hospital delays (e.g, an extra night’s stay in the hospital because of an unavailable surgical suite)
If you need help managing your medical bills, consider:
Asking for family and friends for help. They can open mail, match EOBs to bills, and put payment due dates on your calendar.
Reaching out to a case manager: Some insurance companies provide their customers with case managers to help them navigate medical care, health insurance policies, and bills. But it is important to remember that they work for the insurance company. You still need to keep track of every conversation, write down who you talked to, the date you talked to them, and what you discussed.
Hiring a professional bill reviewer: A professional bill reviewer or medical claims organization can help you with things like doing a comprehensive review of our medical bills to make sure they are accurate and checking diagnosis codes for upcharges. The Alliance of Claims Assistance Professionals has referrals: www.claims.org.
When your Insurance Plan Says No …
At some point during your cancer treatment, you may experience a denial of coverage from an insurer, whether for an imaging scan, prescription drug, treatment, procedure, or genetic test. Most people take “no” for an answer. But those who don’t accept the denial, and file an appeal, may actually win and get coverage for the care prescribed by their health care team!
For more information about appealing a claim denial, read the Quick Guide to Appeals for Employer- Sponsored & Individual Insurance at https://TriageCancer.org/QuickGuide-Appeals or watch this webinar, “When an Insurance Company Says No:” https://vimeo.com/triagecancer/understandingappeals.
Getting Organized
There are lots of tools available to keep track of your medical bills, EOBs, medical records, and other paperwork related to your medical care. But the key is to use whichever tool is going to make it easier for you to stay organized, whether that is a box with file folders or a 3-ring binder. You should also keep track of any communications that you have with your provider and health insurance company.
If you need to appeal any denials of coverage, you can use this Appeals Tracking Form: https://triagecancer.org/AppealTrackingForm.
You can also watch this webinar on staying organized:
https://triagecancer.org/webinarreg-organize.
One reason it is important to stay organized is that tracking all of your expenses related to your medical and dental care could actually save you money.
- If you need to get a pre-authorization, keeping that in a safe place is useful, in case your insurance company says they never gave approval.
- You should also keep track of all medical and dental costs, including meals, lodging, and travel expenses related to medical care, because these expenses might be tax-deductible, or possibly paid for through a flexible spending account (FSA).
Paying Your Medical Bills
If you get a medical bill that you are unable to pay, it is important not to ignore it. Consider contacting your provider to ask for more time, or see if your provider would be willing to negotiate a payment plan or accept a lower lump-sum payment.
It is also important not to wait too long to contact your provider about an unpaid medical bill. Contacting your provider before unpaid bills get sent to collection agencies can help protect your credit score.
Be careful when you’re considering paying medical bills with credit cards. They usually have high interest rates and you could end up spending more than necessary. You should also be careful when considering taking out a home loan to pay off medical debt. Using your home as collateral transfers the debt from being unsecured to secured, which means that the lender could take your home if you are unable to make payments.
You can apply for financial assistance programs to help offset the cost of your medical bills.
Visit https://TriageCancer.org/Cancer-Finances for financial assistance resources.
Disability Benefits Help
Disability Benefits Help is an independent organization dedicated to helping people of all ages receive Social Security disability benefits and maintain eligibility once approved by connecting them with disability advocates or attorneys.
By offering free case evaluations, Disability Benefits Help has helped over 3.5 million applicants access the support they need to navigate the Social Security Disability system and alleviate financial burdens caused by medical conditions like cancer.
https://www.disability-benefits-help.org/form/eval-123
Disability-Benefits-Help.org is committed to helping the disabled receive Social Security Disability benefits. We are NOT affiliated in any way with the Social Security Administration, but help individuals applying for disability benefits for the first time and those already denied by SSA. To get help with your disability claim, click here.
Disability Benefits Help
326 A Street, Unit 1A
Boston, MA 02210
617.849.5892 (fax)
[email protected]
Medications
You can reduce the cost of cancer medications by understanding the way your insurance covers your prescription drugs and taking advantage of available resources.
A good place to start is understanding the language providers and insurers use when discussing prescription drugs. Here are some key terms that are helpful for you to know:
Premium: The premium is the amount you pay monthly to have health insurance. You will pay this amount whether you go to the pharmacy or not.
Deductible: Your deductible is the amount you pay towards prescription drug costs before your insurance company begins to pay their share. This is a fixed dollar amount that you have to pay each year. For example, you might have a $250 prescription drug deductible.
Co-payment: A co-payment is a fixed dollar amount that you pay each time you receive a prescription medication. It tends to vary by plan and can also vary by type of prescription drug.
Co-insurance/Cost-share: These terms mean the same thing, both referring to the set percentage of prescription drug costs that your insurance pays. You may have to pay a co-insurance amount rather than a co-payment amount, depending on the type of prescription drug.
Out-of-Pocket Maximum: This is the maximum amount you will have to pay for your prescription drugs during the year. Typically, everything you pay towards co-payments, deductibles, and co-insurance counts towards your out-of-pocket maximum.
Note: some plans include all of these costs in the medical care benefit and some plans have separate out-of-pocket costs such as co-payments, co-insurance, deductibles, and out-of-pocket maximums for prescription drugs.
Generic vs. Brand-Name Drugs: Brand-name drugs originate from the company that conducted clinical trials of the drug, while generic drugs are essentially copies. Generic drugs have the same features (like dosage, intended use, effects, administration, and risk) of brand-name drugs, but tend to cost less.
Step Therapy: Some insurance companies require patients to go through a process called step therapy when requesting certain prescription drugs. This process involves trying one or more alternative (usually lower-cost) drugs before “stepping-up” to the original drug requested.
There are ways to manage prescription drug expenses.
Some public and private programs let people buy drugs at discounted prices. Others can help people who can’t afford any part of their medicine costs.
Many pharmaceutical companies and specialty pharmacies have assistance programs that may help patients. They may provide co-pay assistance to help people who have health insurance pay for the out-of-pocket costs associated with prescription drugs. They may also be able to provide their prescription drugs at no cost to individuals without health insurance or Medicare beneficiaries. This is sometimes referred to as “free-drug.”
Ask your health care team or contact the company that manufactures the prescription drugs you are taking. The chart found here is a starting point to see what you might have access to. The chart can be sorted by the company that manufactures the drug, the type of cancer (i.e., disease state), or name of assistance program.
Clinical trials for promising cancer drug therapies may offer free or reduced cost prescriptions. Check with your healthcare provider and/or insurance representative.
Ways to cut costs when buying your medications …
Find out if your health plan offers mail-order pharmacy service. You can often get a 90-day supply of medicines mailed to you, which costs less because you pay 1 co-pay instead of 3.
Ask your doctor if generic drugs can be used to treat your health problems. Generics are proven equivalents to brand name drugs and often cost much less. Some health plans charge lower co-pays for generic drugs.
Take all your medicines with you to each health care appointment and review them with your doctor to see if you still need everything you are taking.
Source: TriageCancer
Thank you! Triage Cancer .. you are amazing!
Pharmaceuticals’ Patient Assistance Programs
Source: In collaboration with Cancer Support Community
The following list of pharmaceuticals’ programs is not exhaustive. We have selected the programs most commonly used by cancer patients. Each company provides assistance only for medications it manufactures. If you are not sure which pharmaceutical company makes the medication(s) you have been prescribed, you can ask your health care team or pharmacist for help. Some companies have more than one patient assistance program.
The information below is meant to be a starting place for gathering information about possible assistance. For more information you can check the website www.needymeds.org or www.pparx.org.
AbbVie, Inc. Patient Assistance Foundation
800 222 6885
Provides free medicines to qualifying patients. Financial need requirements vary by medicine and are based on patient’s insurance coverage, household income, and projected out-of-pocket medical expenses.
AgingCare
Search for prescription drug assistance programs by state, medication name, or browse a list of nationwide nonprofit assistance programs.
Amgen Assist 360
888 427 7478
Patients are connected with an Amgen nurse navigator who serves as a single point of contact and who can help find resources that are most important. Nurse navigators are only available to patients that are prescribed certain products. Nurse navigators are there to support, not replace, a patient’s treatment plan and do not provide medical advice, nursing, or case management services.
Amgen 360 can …
Connect you to a reimbursement counselor or schedule a visit with a field reimbursement specialist.
Find co-pay and reimbursement resources for patients with different kinds of insurance or no insurance at all.
Help patients get the answers they need about their Amgen medications.
Amgen Safety Net Foundation
Patients may be able to receive Amgen medications at no cost if they meet the following eligibility requirements:
Have lived in the United States or its territories for six months or longer,
Satisfy income eligibility requirements,
Are un-insured or their insurance plan excludes the Amgen medicine or its generic/biosimilar.
Certain Medicare Part D patients with product coverage who cannot afford their out-of-pocket costs may be eligible. It is required that they are able to demonstrate …
Inability to afford the medicine,
Ineligibility for Medicaid or Medicare’s low-income subsidy,
Have satisfied all payer guidelines and prior authorization requirements prior to applying for assistance,
Do not have any other financial support options.
Astellas Pharma’s Xtandi Access Service
888 427 7478
855 898 2634
AstraZeneca Prescription Savings Program
800 292 6363
There are two programs:
AZ&Me Prescription Savings program for people without insurance,
AZ&Me Prescription Savings program for people with Medicare.
The same application is used for both programs.
Most eligible patients will pay $0 per supply or infusion, depending on the specific medication and subject to annual maximums. There are no income requirements to participate in these programs.
Patients are not eligible if prescriptions are paid by any state or other federally-funded programs including, but not limited to, Medicare Part B, Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), or TriCare, or where prohibited by law. Eligibility rules apply. Offer is invalid for claims and transactions more than 120 days from the date of service.
AstraZeneca Access 360
Provides personal support to help streamline access and reimbursement for select AstraZeneca medicines.
Access 360 provides …
Pharmacy coordination,
Reimbursement support,
Patient affordability.
Bayer U.S. Patient Assistance Foundation
855 969 3445
Helps eligible patients get Bayer prescription medicine at no cost. To be eligible, patients must …
Live in the United States or Puerto Rico,
Meet certain income limits,
Not have insurance or have coverage for their Bayer prescription medication.
Bayer’s REACH
866 639 2827
Zero Copay for Bayer
Bayer’s Xofigo Patient Assistance
855 696 3446
Bayer’s Zero Copay
866 581 4992
BenefitsCheckUp
Provided by the National Council on Aging, this online resource for people age 55 and older who find it hard to pay for their medicines, health care, utilities, food, and other basic needs.
BenefitsCheckUp helps you find state, federal, and private benefits programs where you live in all 50 states and the District of Columbia. This service can find drug assistance programs that might work for you.
The website also includes questionnaires that search for programs to help with rent, food, housing, property taxes, and other needs.
Boehringer Ingelheim CARES Foundation Asistance Program
800 556 8317
Provides medicines free of charge to un-insured and under-insured U.S. patients who meet our eligibility requirements.
COVID-19 Relief – If you recently lost your job and/or prescription benefits due to COVID-19 and are unable to afford your medicine, you may be eligible to receive your Boehringer Ingelheim medicine free of charge through our charitable Patient Assistance Program.
Bristol-Myers Squibb
800 736 0003
Bristol Myers Squibb (BMS) is committed to helping appropriate patients get access to BMS medications by providing access and reimbursement support services.
BMS Access Support offers benefits reviews, prior authorization assistance, and appeal process support, as well as an easy-to-initiate co-pay assistance process and information on financial support.
BMS Oncology Co-Pay Assistance Program
This program is designed to assist eligible, commercially-insured patients who have been prescribed select BMS medications with out-of-pocket deductibles, co-pays, or co-insurance requirements.
Bristol Myers Squibb Patient Assistance Foundation
Patients may be eligible for BMSPAF if they …
Do not have insurance coverage for the prescribed medication listed on the website,
Live in the United States, Puerto Rico or U.S. Virgin Islands,
Are treated by a U.S. licensed prescriber,
Are being treated as an out-patient
CancerCare Co-Payment Assistance Foundation (CCAF)
We help people with cancer overcome financial access and treatment barriers by assisting them with co-payments for their prescribed treatments. We offer easy-to-access, same-day approval over the phone and online. Offers funding to cover co-payment, co-insurance, and deductibles for chemotherapy or targeted treatment medications only.
A nonprofit organization dedicated to removing insurance barriers by helping qualified patients afford the co-payments, co-insurance, and deductibles for their prescribed treatments. Patients must meet certain financial, medical, and insurance criteria. The funds are disease-specific. The patient’s primary cancer diagnosis must match the program’s fund definition and the medication prescribed must be to treat the primary diagnosis.
If the Foundation does not have funding for the patient’s type of cancer, the co-payment specialists can provide information about other patient assistance programs, support services, and additional resources that may be helpful.
In order to be eligible for assistance:
• Patient’s primary cancer diagnosis must be the same as one of the funds that the foundation covers.
• Patient must have a valid Social Security number to apply for assistance and receive treatment in the United States.
• Patient must be in active treatment or have a treatment plan in place prior to applying for assistance.
• Patient is required to have valid insurance coverage. Some funds are restricted to assist only those insured through a federal health insurance program, such as Medicare or TriCare.
• Patient income level must be at or below 500% of the Federal Poverty Level.
Patients can apply for this foundation through its online process (cancercare.org/copay-apply) or speak with a co-payment specialist at 866.55.COPAY (866.552.6729). Patients will be enrolled for up to one year from the time they are approved.
Cancer Financial Assistance Coalition
A coalition of financial assistance organizations joining forces to help patients with cancer experience better health and well-being by limiting financial challenges. It educates patients and providers about existing resources and links to other organizations that can disseminate information about the collective resources of its member organizations.
CFAC is a coalition of organizations and cannot respond to individual requests for financial assistance. To find out if financial help is available, use the CFAC database at cancerfac.org. Search by cancer diagnosis or by specific type of assistance or need (i.e., co-pays, general living expenses, transportation, genetic testing). Patients and providers may also contact each CFAC member organi- zation individually for guidance and possible financial assistance.
Offers health insurance co-payment assistance up to $10,000 per year to eligible patients for chemotherapy and targeted therapy drugs. They currently offer this program to people affected by breast cancer, colon or colorectal cancer, glioblastoma, head and neck cancer, non-small cell lung cancer, pancreatic cancer, and renal cell cancer.
Celgene Patient Support
800 931 8691
Dollar For
Dollar For is a national nonprofit that crushes medical bills by empowering patients and advocating on their behalf.
Dollar For helps you apply for financial assistance from your hospital. We don’t pay your bills — we get the hospital to forgive them.
Our services are completely free. We are 100% funded by generous donors.
The Affordable Care Act requires non=profit hospitals to offer charity care programs to keep their tax-exempt status. These financial assistance programs reduce or eliminate medical bills for low-to-middle income patients.
Unfortunately, hospitals hold all the power. There is almost no federal oversight of charity care, so most hospitals do the bare minimum to educate patients about these programs. A recent study showed that 72% of nonprofit hospitals spent less on charity care and community investment than they received in tax breaks. Combined, nonprofit hospitals in 2018 received $17 billion in tax breaks that were not passed on as community benefits.
Dollar For is here to help. We educate patients about these programs, help patients navigate the application process, and call out hospitals that don’t follow regulations. We have already crushed over $19 million in medical bills. Our work is entirely funded through philanthropic grants and donations. Our services are completely free – no strings attached.
A medical crisis shouldn’t mean a financial crisis.
Dollar For crushes medical bills by making charity care known, easy, and fair.
U.S. law requires non-profit hospitals to offer “charity care” programs that reduce or eliminate bills for patients whose income is below a certain level. Learn more about charity care.
Dollar For can help you find out if you qualify for charity care. On average in 2024, households under 212% of the Federal Poverty Level will qualify for free care, and families under 311% will qualify for discounted care. These averages are derived from Dollar For’s national database of hospital financial assistance policies. Once we get your info, we’ll prepare your hospital application and submit it within 1–3 weeks. We’ll handle mailing, emailing, or faxing it to the hospital so that you don’t have to.
Once your application has been submitted, the waiting game begins. We will email and text you to check in and give you tips on following up with the hospital. If needed, Dollar For helps you submit additional documents to the hospital and prepare an appeal. Please make sure to tell us what you hear from the hospital so that we can help!
Most hospitals review applications within 3–8 weeks. That means you are only a few weeks away from debt relief.
Learn more about Dollar For’s services.
Our 2021 viral TikTok on the basics of charity care was seen by over 30 million people. We currently have over 125,000 social media followers. Dollar For has been featured on National Public Radio, the Wall Street Journal, Kiplinger, Kaiser Health News, Consumer Reports, and many other publications. See our pressroom for a full list of press and media.
Our passionate community of supporters educates people in their communities. We also build local awareness of charity care programs through partnerships with other nonprofit and service-focused organizations to spread the word.
Our online eligibility screener—powered by our custom-built database of over 8,200 hospitals—helps patients quickly see if they are likely to qualify for financial assistance.
For eligible people, Dollar For offers self advocacy and full service options to help submit financial assistance applications:
- Our online manual and automated self-service system walk patients through the step-by-step process of applying for financial assistance.
- Our dedicated staff of patient advocates prepare and submit applications, then help patients follow up on cases. Dollar for has already helped patients submit over 3,200 charity care applications.
Questions? Contact [email protected].
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Eisai, Inc. Patient Assistance Program
866-613-4724
Family Wize
Partners with almost all pharmacies to negotiate prescription discounts for patients.
[email protected]
Genentech Patient Foundation
888 249 4918
Genentech Access Solutions is a resource for access and reimbursement support after a Genentech medicine is prescribed. Enroll patients into the program by going to www.genentech-access.com/hcp.html, selecting the prescribed medication and downloading and completing the necessary forms.
Patients qualify if they …
Are uninsured with incomes under $150,00,
Are insured without coverage for a Genentech medicine with incomes under $150,000,
Are insured with coverage for a Genentech medicine, with unaffordable out-of-pocket costs, who have pursued other forms of financial assistance, and with household size and income within certain guidelines.
Genentech Oncology Co-Pay Assistance Program
Helps eligible patients pay for prescription medication costs.
Patients must meet the following criteria …
Be covered by commercial or private insurance,
Receive a Genentech Oncology product for an FDA-approved indication,
Not participate in a federal or state-funded healthcare program, such as Medicare, Medicaid, Medigap, VA, DoD, or TriCare,
Be 18 years of age or older or have a legal guardian 18 years of age or older to manage the program,
Live in and receive treatment in the United States or U.S. territories,
Not be receiving assistance through the Genentech Patient Foundation or any other co-pay charitable organization.
There are no income requirements. Patients pay as little as $5 for their prescribed Genentech oncology product(s) with an annual benefit limit of $25,000 per product. The $5 co-pay applies to FDA-approved Genentech combination products. Retroactive requests for assistance may be honored for qualifying patients if the infusion or prescription fill occurred within 180 days prior to enrollment and the patient meets all eligibility criteria at the time of infusion.
GlaxoSmithKline Commitment to Access
866 265 6491
Together with GSK Oncology
Offers patients and healthcare professionals a variety of access and reimbursement services for all GSK oncology products — all in one place.
Co-pay Program
Eligible commercially-insured patients could pay as little as $0 for their medicine. Download and complete the Together with GSK Oncology enrollment form for approval.
Patients may be eligible based on general criteria …
Have a commercial medical or prescription insurance plan or are uninsured,
Are a resident of the United States (including the District of Columbia, Puerto Rico, and the U.S. Virgin Islands),
Are not eligible for or enrolled in a government funded program.
If the patient is approved, the Together with GSK Oncology Commercial Co-pay Program may help with patient’s cost share for a GSK oncology product and the cost of administration, up to $100 per administration for IV products, up to a program total of $26,000 annually. Residents of Massachusetts, Michigan, Minnesota, or Rhode Island are not eligible for reimbursement of administration fees. Eligibility in the program is for one year. Patients must apply for co-pay assistance each year that they wish to participate in the program.
Patient Assistance Program
Uninsured patients who meet eligibility requirements may access medication free of charge. Medicare patients who meet program requirements may also be eligible for the program.
To qualify for the patient assistance program, patients must live in one of the 50 states, District of Columbia, Puerto Rico, or U.S. Virgin Islands
Meet one of these criteria:
Uninsured,
Have private commercial insurance but have no coverage (medical or pharmacy) for the product as demonstrated to the program through the defined appeals process criteria (please contact program for details),
Not be currently receiving prescription drug coverage through a government program (excluding Medicare), which includes Medicaid, VA, DOD or TriCare benefits,
Not be eligible for Puerto Rico’s Government Health Plan Mi Salud or have applied and been denied,
Meet certain income eligibility requirements. Patients whose income exceeds program eligibility maximum will be provided the opportunity to demonstrate that their eligible medical expenses bring them within the income eligibility criteria (please contact program for details).
Good Days
Good Days is a non-profit advocacy organization that provides resources for lifesaving and life-extending treatments to people in need of access to care.
Good Days covers what insurance does not — the co-pays for treatments that can extend life and alleviate suffering. Good Days also has a premium assistance program for patients who need help paying their monthly medical insurance premiums. Its travel assistance program helps pay for travel costs to ensure patients have access to the care they need.
Good Days has streamlined the enrollment process so patients can receive immediate determination of eligibility for financial assistance.
Eligibility criteria:
Patient must be diagnosed with a covered disease and program must be accepting enrollments
Patient must have a valid Social Security number to apply for assistance and receive treatment in the United States.
Patient must be seeking assistance for a prescribed medication that is FDA approved to treat the covered diagnosis.
Patient is required to have valid insurance coverage.
Patient income level must meet program guidelines.
To enroll, go to mygooddays.org/ apply to apply online, or you can download the English or Spanish enrollment form and fax completed forms to 214.570.3621. Contact GoodDays by phone (877.968.7233), Monday through Friday, from 8:00 AM to 5:00 PM CST.
Formerly known as Chronic Disease Fund.
GoodRX Health
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You have probably heard at least one person in your life tell a story about going to the pharmacy to get a new prescription, only to be shell-shocked by an enormous price tag, even after insurance. As of 2021, an estimated 7% of US adults couldn’t pay for their prescriptions within the previous three months.
Doug Hirsch was prompted to co-found GoodRx, a marketplace that offers coupons for common, mostly generic drugs, in 2011, after being shocked at the high price of a prescription he needed, and the fact that the price varied widely based on what pharmacy he used.
Today, GoodRx’s prescription discount coupons are accepted at “virtually every US pharmacy.”
GoodRx doesn’t set the prices consumers pay for their prescriptions. That’s decided by pharmacy benefit managers (PBMs), who negotiate drug prices with pharmacies or pharmacy purchasing groups. GoodRx just partners with the PBMs to display the negotiated prices on their coupons, and because not every plan covers every drug, these prices can be much lower than what you pay by using health insurance. GoodRx also looks for things like pharmacy savings programs offered by drug manufacturers that bring costs down further.
HealthWell Foundation
A nationally recognized, independent non-profit organization founded in 2003, the HealthWell Foundation has served as a safety net for more than 320,000 underinsured patients by providing access to life-changing medical treatments they otherwise would not be able to afford. HealthWell provides financial assistance to adults and children facing medical hardship resulting from gaps in their insurance that cause out-of-pocket medical expenses to escalate rapidly. HealthWell assists with the treatment-related cost-sharing obligations of these patients.
When health insurance is not enough, HealthWell Foundation fills the gap provides financial assistance to help with:
• Prescription co-pays
• Health insurance premiums, deductibles, and coinsurance
• Pediatric treatment costs
• Travel costs.
Healthwell Foundation offers financial assistance through a number of disease funds, with new funds opening every year, so patients can get the care they need.
To be eligible, patients must meet certain criteria:
HealthWell must have a disease fund that covers the patient’s illness, and their medications must be an eligible treatment for that illness.
Patients must have some form of health insurance, such as private insurance, Medicare, Medicaid, or TriCare.
Patients have incomes up to 400 to 500% of the federal poverty level (HealthWell considers household income, the number in the household, and the cost of living in patient’s city or state).
Patients must be receiving treatment in the United States.
Anyone with the patient’s express permission may apply on behalf of a patient in two ways:
1. Apply online using the HealthWell provider portal at https://healthwellfoundation.secure.force.com/
2. Apply by phone at 800.675.8416, Monday through Friday, 9:00 AM to 5:00 PM EST.
Once patients are approved for a grant from one of the disease funds, they will receive assistance for a rolling 12 months, after which they can reapply if needed and if funding is available. Upon approval, patients will receive both a HealthWell Pharmacy Card and a Reimbursement Request Form.
Funding varies, so check website for up-to-date list of covered diagnoses and medications.
IncyteCARES
855 425 5234
Johnson & Johnson Patient Assistant Foundation (JJPAF)
800 652 6227
Committed to helping eligible patients without insurance coverage receive prescription products donated by Johnson & Johnson operating companies.
Komen Treatment Assistance Program
Offers financial assistance for some medications, medical equipment, and lymphedema supplies
Leukemia & Lymphoma Society’s Co-Pay Assistance Program
Helps cover expenses for medications associated with blood and marrow stem cell transplantation, blood cell boosters, blood transfusions, chemotherapy, intravenous preparation, iron chelation therapy, kyphoplasty, photo-pherersis/uv light therapy, prescription drugs, public or private insurance premiums, radiation therapy, and radio-immunotherapy.
Offers financial help toward:
Blood cancer treatment-related co-payments
Private health insurance premiums
Medicare Part B, Medicare Plan D, Medicare Supplementary Health Insurance, Medicare Advantage premium, Medicaid Spend-down or co-pay obligations
You have complete freedom to choose doctors, providers, suppliers, insurance companies and treatment-related medications. You can make changes to these at any time without affecting your continued eligibility.
Lilly Oncology Support
866 652 6227
Offers personalized treatment support for eligible patients prescribed a Lilly Oncology product.
For those who qualify, it can help with …
Understanding patient’s insurance coverage,
Review of financial-assistance options, including savings card programs and independent patient-assistance foundations
For some products, it provides dedicated, personalized support through every step of treatment.
Lilly Cares Foundation Patient Assistance Program
855 559 8783
Assists qualifying patients in obtaining certain Lilly medications at no cost.
Lilly Oncology Infused Products Co-Pay Program
Eligible, commercially-insured patients may qualify for savings card assistance, which may help patients manage treatment costs. Patients must first pay a portion of their co-pay or coinsurance ($25 for each dose of the prescribed Lilly Oncology medicine). The program will cover the remainder of patient’s co-pay or co-insurance for the prescribed Lilly Oncology medicine, up to a monthly cap of wholesale acquisition cost plus usual and customary fees and a maximum of $25,000 during a 12-month enrollment period.
To be eligible, patients must …
Have been prescribed one of the following Lilly Oncology medicines covered by the program — Alimta, Cyramza, Erbitux, or Portrazza,
Have commercial insurance that covers the prescribed Lilly Oncology medicine, but does not cover the full cost,
Be 18 years of age or older,
Be receiving the prescribed medicine for an FDA-approved use,
Be a resident of the United States or Puerto Rico.
Patients may not be participating in any state or federal healthcare program including, without limitation, Medicaid, Medicare, Medigap, DoD, VA, TriCare, or any state patient, or pharmaceutical assistance program. Patients who move from commercial insurance to a state or federal healthcare program will no longer be eligible.
Live Like Bella
Assists pediatric cancer families with medical co-pays, gas, food, and utilities.
Lone Star Script Care
Lone Star Script Care is a national advocacy organization that works personally with patients and their doctors to help patients get access to medications they need utilizing various Prescription Assistance Programs offered by pharmaceutical companies and their foundations.
As a full service agency, we work directly with you and your healthcare providers to ensure we have all the information we need to complete the initial and ongoing paperwork for each pharmaceutical company and their program requirements.
Specifically, we will:
* Review your current set of circumstances and provide you with an analysis as to what we can or cannot assist you with.
* Prepare all required forms for your healthcare providers approval.
* Assemble and submit all required pharmaceutical company forms and other paperwork on your behalf.
* Follow up with pharmaceutical companies and doctor’s offices regularly to make sure all the ongoing forms are received and processed correctly.
* Automatically manage the refill process to ensure you receive access to the medications you need.
* Annually, we will automatically renew your enrollment to ensure your continued enrollment.
Medicaid
A state-run program funded by the federal and state government. It helps people and families who have very limited incomes. Medicaid pays for health care costs such as doctor visits, hospital visits, and prescription drugs. You can find eligibility requirements and general information at the website above.
Benefits vary from one state to another. In some states, the program may have a different name (TennCare, Medi-Cal, etc.). Contact your State Health Department for more information on requirements and how to apply. To find your State Health Department, go to www.medicaid.gov or call the US Department of Health and Human Services at this toll-free number: 1-877-696-6775.
Medicare
The United States health insurance program is for people age 65 or older although certain younger people with disabilities might also qualify.
This federal government website can help you sign up for Medicare and choose the right Medicare-approved prescription drug plan (called the Part D plan) based on where you live, your income, and the drugs you take. You can join a Part D plan during open enrollment if you already have Medicare Part A and/or Part B. If you had prescription coverage and recently lost it, you may be able to enroll at times other than open enrollment.
There are a number of prescription drug assistance programs in each state. Some of these programs, such as the Extra Help program, are designed to support Medicare beneficiaries, while some offer support state residents who are not enrolled in Medicare. Fortunately, many states that do not offer Extra Help offer other programs to help residents afford their prescription medications. Go to www.medicareadvantage.com for a listing of the state programs.
If you are enrolled in a state pharmacy assistance program including Medicaid, you will probably also be enrolled in Medicare Part D. If you have prescription drug coverage through your current health insurance or get discounts on your prescriptions through other programs, review your coverage closely to see if the Medicare drug plan will save you more money on your prescriptions.
If you don’t qualify for Extra Help, Medicare also keeps a list of drugs that are on private prescription drug assistance plans. You can find the list on their website. You can search by the drug name and find details on the programs and their contact information.
Medicine Assistance Tool
Pharmaceutical Research and Manufacturers of America’s Medicine Assistance Tool (MAT) is a search engine designed to help patients, caregivers, and healthcare providers learn more about the resources available through the various bio-pharmaceutical industry programs. MAT is not its own patient assistance program, but rather a search engine for many of the patient assistance resources that the biopharmaceutical industry offers.
Merck Patient Assistance Program
800 727 5400
Merck Access Program may be able to help answer questions about access and support, including …
Benefit investigations, prior authorizations, and appeals
Insurance coverage for patients
Co-pay assistance
Referral to the Merck Patient Assistance Program for eligibility determination
Reimbursement.
Merck Co-pay Assistance Program offers assistance to eligible, privately-insured patients who need help affording the out-of-pockets costs.
Co-pay assistance may be available for patients who …
Are residents of the United States (including Puerto Rico),
Have private health insurance that covers the prescribed, eligible Merck medicine under a medical benefit program,
Have been prescribed the eligible Merck medicine for an FDA-approved indication,
Meet all other criteria of the program.
The Merck Co-pay Assistance Program is not valid for patients covered under a government program as that term is defined in the terms and conditions. The program is not valid for un-insured patients.
Merck Helps
Provides certain medicines and adult vaccines for free to people who do not have prescription drug or health insurance coverage and who, without assistance, cannot afford their Merck medicines and vaccines. If patients need help paying for their medicines or adult vaccines, the Merck Patient Assistance Program may be able to help.
Individuals who don’t meet the insurance criteria may still qualify for the Merck Patient Assistance Program if they attest that they have special circumstances of financial and medical hardship, and their income meets the program criteria. A single application may provide for up to one year of medicine free of charge to eligible individuals and an individual may reapply as many times as needed.
Eligibility criteria include …
Patient must be a United States resident and have a prescription for a Merck product from a healthcare provider licensed in the United States.
Patient does not have insurance or other coverage for their prescription medicine.
Patient cannot afford to pay for the medicine and meets certain income requirements.
Specific income requirement amounts can be found at www. merckhelps.com.
Select the prescribed medication to see qualifications.
If patients do not meet the prescription drug coverage criteria, their income meets the program criteria, and there are special circumstances of financial and medical hardship that apply to their situation, you can request that an exception be made. Patients do not have to be a U.S. citizen.
National Organization for Rare Disorders
Since 1983, NORD has been the primary source of support and information for patients and families affected by rare diseases. This Resource Center provides patients and caregivers with free webinars, fact sheets, infographics and other helpful materials to guide you on your journey with a rare disease.
Since 1987, NORD has provided assistance programs to help patients obtain life-saving or life-sustaining medication they could not otherwise afford. These programs provide medication, financial assistance with insurance premiums and co-pays, diagnostic testing assistance, and travel assistance for clinical trials or consultation with disease specialists.
Provides assistance programs to help patients obtain medication, insurance premiums and co-pays, diagnostic testing assistance, and travel assistance for clinical trials or consultations.
NeedyMeds
A national non-profit that connects people to healthcare savings and educational resources … free and anonymous.
Do you know …
You can use our drug discount card to save on vaccines? It’s a great way to protect yourself from illness and overspending!
Learn more.
Where to turn when health insurance is not enough?
About the OTC Medicine Safety Game?
How to be safe, smart, and informed when it comes to your meds?
Don’t miss this short and impactful session about NeedyMeds’ healthcare savings resources – your wallet will thank you!
HealthWell: Help Paying for Meds – 3/21 @ 1:00PM ET
Discover how HealthWell supports insured patients in accessing essential medical treatments and copay and premium assistance.
Register now to discover how HealthWell supports insured patients in accessing essential medical treatments. Our grant application process and portals are quick, easy, and free of charge. Sign up today to learn more about our programs that provide copay and premium assistance across 90 disease areas.
Affordable Meds with Rx Outreach – 3/25 @ 1:30PM ET
Access budget-friendly meds with Rx Outreach, the nation’s largest non-profit, fully licensed, digital pharmacy.
Access to Fertility Preservation – 3/26 @ 2:00PM ET
Learn about state laws that provide access to fertility preservation, what to do if you’re denied coverage, and more.
Vitamins, Supplements & Liver Disease – 4/2 @ 1:30PM ET
Whether you’re a patient, caregiver, or provider, join to discover evidence-based strategies to promote optimal liver function.
Make the Most of Medical Appts – 4/10 @ 2:00PM ET
Learn how to prepare for your next medical appointment to be sure you discuss important issues and leave with a plan in place.
Help for the Underinsured – 4/16 @ 1:00PM ET
If you’re living with a chronic or rare disease, turn to the PAN Foundation. They help with out-of-pocket treatment costs and more!
How to Get Hospital Bills Waived – 4/24 @ 3:00PM ET
National nonprofit, Dollar For, explains how easy it can be to crush those hospital bills! Sign up now as space is limited.
Triage Health: Estate Planning – 4/30 @ 1:00PM ET
This webinar will cover things to consider when creating your estate plan and how to protect your medical decision-making rights.
Novartis Oncology Patient Assistance Now
800 245 5356
Through one-on-one guidance with a dedicated case manager, patients will discover which Novartis Oncology Patient Support programs they are eligible to receive and may also be referred to other services.
Support for patients includes …
Information about financial assistance that may be available
Patient support counselors who are able to provide information in more than 160 languages
Patient navigators who provide one-on-one support specific to a patient’s Novartis medication
Dedicated case managers with private extensions who can be contacted directly for updates on patients
Insurance benefits verification, including information on prior authorizations and denial appeals
A combination of PANO case managers and/or field reimbursement managers are available to help, depending on the case complexity of a patient’s case.
Novartis Patient Assistance Foundation
Provides access to Novartis medicines to patients experiencing financial hardship and/or have no third-party insurance coverage for their medicines. Please be advised that access to the medicines distributed through the Novartis Patient Assistance Foundation, Inc. is free of charge to all eligible patients.
To be eligible patients must …
Be a United States resident
Provide proof of income that meets financial eligibility requirements
Have limited or no prescription coverage. (Exceptions exist for individuals with limited prescription coverage.)
Novartis Oncology has made it easy for patients with private insurance to access financial support for their prescription co-pay costs on almost all Novartis Oncology medications.
Eligible, privately insured patients may pay $25 per month and Novartis will pay the remaining co-pay up to $15,000 per calendar year per product. The Novartis Oncology Universal Co-pay Program includes the co-pay card, payment card, or rebate with a combined annual limit of $15,000. Patients are responsible for any costs once the limit is reached in a calendar year.
This program is not available for patients who are enrolled in Medicare, Medicaid, or any other federal or state health care program. Novartis reserves the right to rescind, revoke, or amend the program and discontinue support at any time without notice. Find out if a patient is eligible to enroll in the program by visiting Copay.NovartisOncology.com or by calling 1 877 577 7756.
Partnership for Prescription Assistance
Helps connect un-insured and under-insured patients who struggle with affordable access to medicines to prescription assistance programs that offer medicines for free or nearly free. It offers a single point of access to information on more than 475 public and private patient assistance programs, including nearly 200 programs offered by biopharmaceutical companies.
A patient or patient advocate simply completes an online form with basic information about prescription medicines, income and current prescription medicine coverage. Then PPA matches the patient with assistance programs for which they may be eligible.
Patient Access Network Foundation (PAN)
The PAN Foundation is an independent, national 501 (c)(3) organization dedicated to helping federally and commercially insured people living with life-threatening, chronic and rare diseases with the out-of-pocket costs for their prescribed medications.
Since its founding in 2004, the PAN Foundation has provided nearly 1 million underinsured patients with grants to help with their out-of-pocket costs through nearly 70 disease-specific programs and transportation assistance. Check your eligibility and apply today.
Helps under-insured people with life-threatening, chronic, and rare diseases get the medications and treatments they need by assisting with their out-of-pocket costs and advocating for improved access and forms.
This Foundation provides financial support for out-of-pocket medication costs to treat several types of cancer, providing co-payment assistance from $500 to $23,000 per year.
Patients and providers and pharmacy staff on the patient’s behalf can apply for assistance using the online self-service portals at www.panfoundation.org/get-help/apply-for-assistance/ or by calling 866.316.7263, Monday through Friday, 9:00 AM to 7:00 PM EST.
To qualify for a financial assistance program, patients must …
Be getting treatment for the disease named in the assistance program,
Be taking a medication that is covered by their health insurance and listed in the assistance program,
Have an income at or below the Federal Poverty Level specified by the assistance program,
Live and receive treatment in the United States or U.S. territories. They don’t have to be a U.S. citizen.
The PAN Foundation offers nearly 70 disease-specific assistance programs. Our assistance programs help patients pay for their out-of-pocket costs, including deductibles, co-pays and co-insurance, health insurance premiums, and transportation expenses to get to treatment.
Patient Advocate Foundation
We put patient and family peace of mind above all else. We provide direct payment for co-pays, co-insurance, and deductibles for patients who need financial assistance. In some instances, assistance with insurance premiums and/or ancillary services associated with the disease also may be available. Patients approved for assistance are required to have their verified diagnosis and treatment plan along with supporting documentation completed and returned within 30 days of approval to ensure continuation of the award. Eligibility requirements:
- Patients must be currently insured and have coverage for medication(s) seeking financial assistance.
- Patients must have a confirmed diagnosis and treatment plan.
- Patients must reside and receive treatment in the United States.
- Patients’ income must fall at or below 300 percent or 400 percent of the Federal Poverty Guideline (FPG) with consideration for the Cost of Living Index (COLI) and number in the household.Once approved, the award can be used immediately. Claims should be submitted via the Virtual Pharmacy Card, uploading them to the online portal, or faxed to PAF using the unique bar-coded fax cover sheet.Patients and providers can apply online (https://copays.org/portal/#/ login) or by calling 866.512.3861. If applying via phone, applications and supporting documents must be faxed to the unique bar-code on the application.
Provides direct services to patients with chronic, life-threatening, and debilitating diseases to help access care and treatment recommended by their doctor. It offers the following services:
Case management services
Professional case managers at PAF work with the mission to identify and reduce the challenges that individuals have when seeking care for their disease. Case management services are available on behalf of patients meeting all of the following criteria …
Have a confirmed diagnosis of a chronic disease, a life-threatening disease, or debilitating disease, or be seeking screening services related to symptoms or suspicion of a chronic, life-threatening, or debilitating disease
Be in active treatment, had treatment within the past six months, or going into treatment in the next 60 days
Be a United States citizen or permanent resident of the U.S.
Be receiving treatment at a facility in the U.S. or in a U.S. territory.
To connect with case management services, call 1.800.532.5274 or apply online at patientadvocate.org
MedCareLine
A division of PAF, the MedCareLine’s team of professional case managers assists with disability, health insurance navigation (e.g., prior authorization, appeals for denied services, second opinion options), and screening for clinical trials. The case managers also assist patients who are experiencing financial challenges that are impacting their ability to pay for care and basic cost of living expenses like housing, utilities, food and transportation, researching and linking them to available financial support programs that may meet some of these needs. Uninsured patients are also supported by the program with direct support in accessing public programs, health insurance enrollment, and charity care that will allow access to necessary care.
Co-Pay Relief Program
The PAF Co-Pay Relief Program, one of the self-contained divisions of PAF, provides direct financial assistance to insured patients who meet certain qualifications to help them pay for the prescriptions and/or treatments they need. This assistance helps patients afford the out-of-pocket costs for these items that their insurance companies require.
This fund is currently closed to new and renewal applications due to lack of sufficient funding. CPR allocates funding to all patient’s that are approved for a grant so that it is available when needed by the patient. Therefore, during the period that a fund is closed to new applications, CPR continues to provide support to all patients in those funds that have an active award. Funds reopen often so please continue to visit our Disease Fund page to check the status of the fund.
Fund Type
- Co-pay, Co-insurance & Deductibles
- Office visits and administration charges related to treatment
- Medical Insurance premiums
Maximum Award Level
$3,500 Per Year
Would you like to be notified when any new funds open, or when any of our current funds re-open? If so, please sign up using the “Get Notified” link below. As a member of our subscriber community, you will receive important news about all of our disease funds, so join today!
Financial Aid Funds
This independent division of Patient Advocate Foundation provides small grants to patients who meet financial and medical criteria. Grants are provided on first-come first-served basis and are distributed until funds are depleted. Qualifications and processes for each fund may differ based on fund requirements. Patients who are interested in applying for financial assistance should start by calling this division at 855.824.7941 or by registering an account and submitting an application online at financialaid.patientadvocate.org. For questions, call 1.800.532.5274, Monday through Friday, 8:30 AM to 5:00 PM EST.
Patient Services, Inc (PSI)
The founder of PSI shaped the very first non-profit patient assistance model in 1989 and knows the pain firsthand of watching a loved one fight-and-lose their battle against chronic illness; he knows, too, the crippling financial burden often carried by those left behind. Since our inception in 1989, Patient Services has been a pioneer leading the charge to find solutions to the challenges that face the chronically ill in the United States.
We provide financial support and guidance for qualified patients with specific, rare chronic diseases. Through PSI assistance programs patients and their families rediscover hope and health.
Provides peace of mind to patients living with specific chronic illnesses by providing financial assistance to eligible persons by:
- Subsidizing the cost of health insurance premiums
- Providing pharmacy and treatment copayment assistance
- Providing travel assistance
Supports people with chronic illnesses and conditions through locating solutions with health insurance and assisting with premiums and prescription co-payments.
Pfizer Oncology Together
877 744 5675
Provides access and reimbursement support, as well as help identify financial assistance options, so patients can get their prescribed Pfizer Oncology medicines.
Eligible, commercially-insured patients may pay as little as $0 per month for their oral medications or per treatment for injectable medications through these co-pay savings programs. For oral products, patients may receive up to $25,000 in savings annually. For injectable products, the maximum annual patient savings range from $10,000 to $25,000.
Patients are not eligible for these programs if they are enrolled in a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TriCare, Veterans Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico. For oral products, the offer will be accepted only at participating pharmacies. This offer is not health insurance. Pfizer reserves the right to rescind, revoke, or amend this offer without notice. For more information, call 1.877.744.5675 or visit www.pfizeroncologytogether.com.
Pfizer Patient Assistance Program
Eligible patients may receive up to a 90-day supply of Pfizer medication for free, while applying for Medicaid. If patients do not qualify for Medicaid, they may be able to get a one-year supply of medication for free through the Pfizer Patient Assistance Program. Patients must meet eligibility requirements and reapply as needed.
To be evaluated for assistance through the Pfizer Patient Assistance Program, healthcare professionals and their patients must submit a completed enrollment form. Patients must also provide proof of income, such as the prior year’s tax return, a W2 form, or a paycheck stub. They also must …
Have a valid prescription from a healthcare provider licensed in the United States or a U.S. territory for the Pfizer medication for which they are seeking,
Have no prescription coverage, or not enough coverage, to pay for their Pfizer medication,
Meet certain income limits, which are subject to change on an annual basis and will vary depending on household size
Reside in the U.S. or a U.S. territory,
Not be treated in an inpatient setting of care, such as a hospital or nursing home.
Pfizer RxPathways® connects eligible patients to a range of assistance programs that offer insurance support, co-pay help, and medicines for free or at a savings.
Visit www.pfizerrxpathways.com to search by the prescribed medication’s name and see which available programs are right for patients.
PhRMA (Pharmaceutical Research and Manufacturers of America)
Maintains a directory of patient assistance programs for prescription drugs. Through these programs, PhRMA member companies supply free medicines to eligible low-income patients.
Pfizer connects eligible patients to a range of assistance programs that offer insurance support, co-pay help, and medicines for free or at a savings.
Purdue Patient Assistance Program
800 599 6070
Rx Assist
Offers a comprehensive database of patient assistance programs, as well as practical tools, news, and articles so that healthcare professionals and patients can find the information they need.
Go to rxassist.org/search and search by either medication name or company name.
RxAssist Prescription Savings Card
Patients can save up to 85 percent where they already fill their prescriptions. Savings are possible with or without insurance, and there is no additional cost to use the card. RxAssist guarantees the lowest price between its discounted price, patients’ insurance co-pay, or the pharmacy cash price.
Visit rxassist.org/coupon/generic?type=patients, or call 1.877.537.5537 for more information.
Rx Hope
RxHope is exactly what its name implies … a helping hand to people in need in obtaining critical medications that they would normally have trouble affording. We act as your advocate in making the patient assistance program journey easier and faster by supplying vital information and help.
Healthcare providers and their staff can set up accounts online to order free medications for their patients through the RxHope automated patient assistance online system.
RXOutreach
A fully-licensed nonprofit mail order pharmacy that ships medications directly to patients’ homes or the provider’s office. To make this process simple and cost-effective, RxOutreach ships enough medication for 30, 60, 90, or 180 days at a time. RxOutreach is available to qualifying individuals and families. Patients can be on Medicare, Medicaid, or other health insurance and still qualify.
It serves people whose income is at or below 400 percent of the Federal Poverty Line.
Sandoz
1 844 726 3691
Sandoz One Source provides comprehensive patient support services designed to help simplify and support patient access.
Available services include …
In-home injection training
Commercial co-pay program
Independent foundation information
Patient assistance program
Reimbursement support.
Commercial Co-Pay Program
Supports eligible, commercially-insured patients with their out-of-pocket costs for Zarxio or Ziextenzo. There are no income requirements. The virtual co-pay card ensures that patients have immediate access to their benefits.
Patients may pay $0 out-of-pocket for the first dose or cycle and for subsequent doses or cycles up to a maximum benefit of $10,000 annually. This program is for insured patients only; cash-paying or uninsured patients are not eligible.
Sanofi’s Patient Connection™
888 847 4877
833 930 2273
CareASSIST offers support for eligible patients prescribed Sanofi Genzyme oncology medications, including …
Access and reimbursement
Financial assistance
Resource support
CareASSIST Co-pay Program
Eligible patients with commercial insurance may pay as little as $0 for their Sanofi Genzyme medicines, including any product-specific co-pay, coinsurance, and insurance deductibles — up to $25,000 in assistance per year.
To be eligible, patients must …
Have commercial or private insurance, which includes state or federal employee plans and health insurance exchanges
Be residents of the United States or its territories or possessions.
There is no income requirement to qualify for this program. Eligible patients will remain enrolled in the program for 12 months dating from the time of approval. Patients will be evaluated for continued eligibility on an annual basis. As appropriate, their enrollment will be renewed. Other conditions apply.
CareASSIST Patient Assistance Program
For patients who meet program eligibility requirements for financial assistance through CareASSIST, medication can be provided at no cost.
In order to be eligible, patients must meet the following requirements …
Patient must be a resident of the United States or its territories or possessions and be under the care of a licensed healthcare provider authorized to prescribe, dispense, and administer medication in the U.S.,
Patient must have no insurance coverage or lack coverage for the prescribed therapy,
Patients with Medicare Part B with no supplemental insurance coverage may be eligible,
Patient must have an annual household income that does not exceed the greater of $100,000 or 500 percent of the current Federal Poverty Level.
SeaGen Secure
855 473 3263
Assists helping cancer patients in certain Ohio counties with household expenses, drug and medications costs, and transportation.
Single Care
Works directly with pharmacies to negotiate up to 80% off prescription prices. It passes these savings onto its members free of charge. Start with a search to look up prescriptions to find the lowest price in your area. Then download, text, or email to yourself a free SingleCare coupon card. The card can be used at participating pharmacy locations. Show the coupon card to your pharmacist and the savings will be applied automatically.
The card is not a health insurance policy and is not intended as a substitute for health insurance. The card allows patients to obtain discounts on prescription drugs and/or pharmaceutical products purchased through participating pharmacies. The range of the discounts will vary depending on the prescription drug or other product and the participating pharmacy. Patients are required to pay for all prescription drugs at the time of purchase.
SingleCare does not make payments to any pharmacy or health care provider.
For more information, visit SingleCare.com or call 844.234.3057.
Takeda Oncology
Takeda Oncology Here2Assist is a comprehensive support program committed to helping patients navigate coverage requirements, identify available financial assistance, and connect with helpful resources throughout their therapy.
Takeda Oncology Co-Pay Assistance Program
For patients with commercial insurance concerned about their out-of-pocket costs for Alunbrig, Iclusig, or Ninlaro, the Takeda Oncology Co-Pay Assistance Program may be able to help. Patients could pay as little as $10 per prescription with an annual maximum benefit of $25,000.
This offer cannot be used if the patient is a beneficiary of, or any part of their prescription is covered or reimbursed by any federal or state healthcare program (Medicare, Medicaid, TriCare, Veterans Administration, Department of Defense, etc.), including a state or territory pharmaceutical assistance program, the Medicare Prescription Drug Program (Part D), or if patients are currently in the coverage gap, Medicare Advantage Plans, Medicaid Managed Care or Alternative Benefit Plans under the Affordable Care Act, or Medigap, or insurance that is paying the entire cost of the prescription. Patients must be at least 18 years old. Additional terms and conditions apply.
To enroll, visit takedaoncologycopay.com or call Takeda Oncology Here2Assist case manager at 1 844 817 6468.
Takeda Oncology Patient Assistance Program
If patients do not have insurance or the prescribed medication is not covered by their insurance, they may be eligible to receive their medication at no cost through this program. To be eligible for the Patient Assistance Program, patients must meet certain financial and insurance coverage criteria.
If the patients qualifiy, they may be enrolled for up to one year. Upon enrollment, a Takeda Oncology Here2Assist case manager will notify the patient and the healthcare provider. A one-month supply of their medication will be delivered to the patient at no cost. Each month, a Takeda Oncology Here2Assist case manager will confirm with patients and their providers that they are still being treated and are eligible to receive another month’s supply of medication.
RapidStart Program
If patients experience a delay in insurance coverage determination of at least 5 days, they may be eligible to receive a one-month supply of their medication at no cost.
Teva Oncology’s CORE
888 587 3263
TogetherRx Access
Offers a free prescription savings card for those not eligible for Medicare or for those who don’t have prescription drug coverage and meet certain household income levels.
Together with Tesaro
844 283 7276
Gail Lemaire says
There are some promising resources here, thanks Nancy.