January deductibles are approaching fast and many pre and post-transplant recipients go through obstacles obtaining medication at an affordable cost. This year I felt the need to go in depth and add clarification. So, let’s go.
What is the difference between Patient Assistance Programs and Foundations?
Patient Assistance Programs (PAPs are programs created by pharmaceutical and medical supply manufacturers to help financially needy patients purchase necessary medications and supplies) Via these programs, prescription medications may be made available at no cost or at a minimal fee for individuals who do not have insurance or are underinsured. We need to redefine the definition that Patient Assistance Programs are for everyone that needs affordable medications. These are geared to help to the commercially insured.
Foundations were created to help address the needs of individuals who cannot afford their prescription drug bills or medical costs. This includes expenses ranging from insurance copayments, coinsurance, premiums, or any of the various other out-of-pocket health care costs.
It is hard when you are trying to get through the matrix of insurance plans, what they cover, what they don’t cover, will they reconsider my medication to a lower tier? Wait, now I am on Medicare and I don’t have any resources! But, you do.
What do they cover?
Copay Assistance
You are asking the pharmaceutical company or the foundation to assist with the amount you pay after your insurance company has paid for qualifying medications.
Premium Assistance
You are asking the foundation to assist with the amount you pay to your insurance company to have medical or prescription coverage.
 How to Apply
Patient Assistance Programs and Foundations ask for the same information. I know it sounds difficult but once you do one take that information and apply it to other programs.
- Your name and contact information.
- What is your income? This is not meant to disqualify you; your information is secure.
- How many in your household?
- Family member contact.
- Insurance information.
The items below can come from your after-care summary
- Doctor and Transplant Coordinators information (verification of illness, disorder, transplant, medication needs) Those coordinators work extremely hard for you and will respond quickly.
- Patient History.
- Name of Prescription Medication.
Now you are rolling!
The information you will be giving is sensitive to everyone and in this case fax machines are used. Yes, I said fax machines. The information goes to a dedicated person of the organization. It then goes to your Doctor or Coordinator to complete. It takes time but allow a couple of days for the process. Do not forget to follow up with all parties involved.
Ask yourself these questions before applying to a Foundation:
Have you contacted the manufacturer of your medication to ask about possible patient assistance program? Some pharmaceutical companies have programs that allow them to work with Medicare.
- Verify to see if the Foundation covers the drug or the disease for which you are applying. This is important. If the drug is covered under an illness and not preventative you will not qualify if you have not been diagnosed with the illness covered.
2. Most drug manufacturers (pharmaceutical companies) offer Patient Assistance Programs (PAPs) for insured        patients who cannot afford their medications. In many cases, these drug manufacturer PAPs offer MORE           assistance than what some foundations can offer.
3. Submit your application one time only but verify it was received. Submitting multiple online applications will        not expedite approval of your grant and may delay the approval process.
4. You CAN apply anytime during the year.
Just a note to remember; the people on the other end of the call want to help you!
Our MEDICATION RESOURCE page has links to some of the websites. They are amazing and extremely helpful! These pharmaceutical companies and foundations will NEVER ask for payment information.
I hope this information saves time and helps you!
