1. What is a Patient Assistance Program
2. Which patients do PAP’s serve?
3. Who qualifies for Patient Assistance Programs?
4. Do all drugs have a program and are there programs for over-the-counter medications?
5. How do patients apply for the programs?
6. What web sites and informational resources are out there?
7. What information is needed for applying?
8. What information needs to be provided with an application?
9. How much medication will be shipped?
10. Where will the medication be sent?
11. Is there a fee to enroll in the PAP'S and is there a charge for the medicines?
12. How long does it take to get the free medicine from the company?
13. What can a patient do if they are slightly over a company's income limits and are in serious need of the medication?
14. In some instances a patient will apply for assistance from the companies without the help of an advocate or liaison. What can the patient do if their physician will not complete the applications?

1. What is a Patient Assistance Program?

A patient assistance program provides prescription medicines to needy patients who do not have prescription drug coverage or who are underinsured through either private and/or government health plans.

2. Which patients do PAP’s serve?

PAP’s primarily serve patients who do not have prescription insurance, who do not qualify for government-funded programs (e.g., Medicaid), and who do not have the means to pay for their medicines.

3. Who qualifies for Patient Assistance Programs?

Each company determines the eligibility criteria for its program (eligibility criteria and the application process vary) General eligibility criteria involve income requirements, family size and status of insurance coverage for prescription drugs. Some companies will provide certain medications to patients who have prescription insurance once they are capped out on quarterly or annual allowances. Some companies will only consider a patient eligible for approval if their income does not exceed the federal poverty guidelines. Others may qualify patients if their income is higher than federal poverty guidelines. (Federal poverty guidelines may be found at: http://aspe.hhs.gov/poverty/poverty.shtml

4. Do all drugs have a program and are there programs for over-the-counter medications?

Normally only brand name products have programs that provide them at no cost. Express Scripts offers generic drugs for certain (but not all) brand name drugs if no program is available. They offer generic drugs at a reduced cost. Needymeds has a list of medications and procedures for applying to Express Scripts by accessing the RX Outreach Program under their Programs list.There are no programs yet available that provide OTC drugs at no cost.

5. How do patients apply for the programs?

Patients may individually, or with the assistance of a patient advocate or liaison (e.g. social worker, physician, pharmacist, pharmacy technician) obtain an application or contact the companies to request an application be faxed or mailed to them or to receive phone approval for acceptance. Applications can also be accessed via one of the many resources available on the internet.

6. What websites and informational resources are out there?

Manufacturer, disease & specialty organizations, and federal and state programs can be found on this site. Local state commissions on aging will also provide information on where a patient can look for assistance.

7. What information is needed for applying?

Each individual pharmaceutical company has its own eligibility criteria. The criteria may include one or more of the following: income guidelines; citizenship status; asset guidelines; veteran’s benefits status; and prescription benefits currently received through other programs such as Medicaid. In addition a patient data collection form can be useful in ensuring information is available.

8. What information needs to be provided with an application?

Income documentation is almost a requirement with all applications. A company may also request proof of denial from government or state programs. Acceptable forms of income documentation include copies of the following:
• Federal Tax return (form 1040, 1040EZ, etc.); for those not filing a federal income tax form last year, you can include:
o wage and tax statement (W-2);
o Social Security and Disability Benefit verification statement;
o interest income, pension, or annuity statement; or
o current employee check stubs for all employers.

9. How much medication will be shipped?

This will vary by company. In most cases a 90-day supply will be sent.

10. Where will the medication be sent?

Unless specifically stated on the application that a drug will be shipped to a patient’s home, most shipments go to the physician’s address that is listed on the application. Suggestion: Most physicians in clinics or private practice do not want to get involved in the receipt and distribution of these medicines. Shipment to a pharmacy would allow the opportunity to offer counseling and proper labeling in dispensing. However, most companies will not ship to a pharmacy. To make allowances for this, this pharmacy run program requests medicines for the physicians and lists the physician address as being c/o this clinic at this Suite number.

11. Is there a fee to enroll in the PAP’S and is there a charge for the medicines?

Generally, there is no fee to apply for assistance. Free Medicine Program has a one time $5 processing fee, but will refund that if they are unable to find assistance in obtaining the prescription medicines for free or at a reduced cost. Some companies send certificates or vouchers that the patient turns in to the pharmacy to receive their medication at no cost. The SelectCare Benefit Network offers a $30/month membership to qualified individuals. The members are able to buy over 1400 brand name and a many generic medications for $15/month. Several retail pharmacy chains offer a month’s supply of generic medications for $4, including Target, Wal-Mart and K-Mart. See the companies’ websites for current medication lists.

12. How long does it take to get the free medicine from the company?

Turnaround time varies. The average turnaround time is 3 to 4 weeks from the time a completed application is received to the time the medication arrives; but it can take anywhere from 2 to 6 weeks. A patient or advocate can call the company and request the status of their application and ask when they can expect the medicines to be shipped and if the application was completed properly.

13. What can a patient do if they are slightly over a company’s income limits and are in serious need of the medication?

Sometimes a company will accept an appeal letter or a letter of medical necessity from the physician that accompanies the application explaining the extenuating circumstances of the financial hardship that purchasing their needed medication would cause. These are considered on a case by case basis.

14. In some instances a patient will apply for assistance from the companies without the help of an advocate or liaison. What can the patient do if their physician will not complete the applications?

Rich Sagall of the needymeds.com website makes a few suggestions of what a patient should do when their physician won’t complete the forms.
• Make sure you have completed everything on the form you can. Not only should you complete the applicant’s section, but anything else you can do. This may include the physician’s name and address, phone number, etc. (Suggestion: have the application signature ready to present to the physician at the time of requesting a prescription to accompany it.)
• Bring all the information your doctor may need. For example, some programs require proof of income. If so, attach whatever documents are required.
• Bring an addressed envelope with the appropriate postage.
• Don’t expect your doctor to complete the form immediately. A busy doctor may not have time to read the form while you are in the office.
• If you encounter resistance, tell your doctor that without his/her help, you won’t be able to obtain the medicines he/she is prescribing.
• If all else fails, you may need to find a physician more sympathetic to your plight and willing to help you.