Depending on the type of insurance coverage you have (Commercial/Private or Government/Public) you may be eligible for different types of copay assistance when prescribed a high-priced oral medication. Below is a summary of those assistance programs and their eligibility requirements. Our Pharmacy Concierge will investigate if these options are available for your medication(s).
Patients who have commercial/private insurance, regardless of whether it was purchased individually or by an employer, may be eligible to receive a co-pay card for certain medications. These are discount cards offered by the drug manufacturer that may cover your deductible amounts up to a maximum limit designated by the manufacturer. Copay cards are normally only for brand name drugs and may not be available for many medications.
Patients who have government/public insurance and are within a certain income/household size threshold may qualify for a grant that would cover their Part D coinsurance. These foundations are donation-based and designate funding by disease/diagnosis for each of their personalized programs. Income limits are decided based on the Federal Poverty Level percentage of 400-500%; for a household of one, this equates to around $49k to $62k per year, or, for a household of two, around $67k to $84k per year. Patients under this threshold and have Medicare Part D should always inquire about applying for these types of assistance. These grants will usually cover patients’ doughnut hole/coverage gap and catastrophic coinsurance amounts for 6-12 months. If there is no funding available, the next step is to investigate assistance with the drug manufacturer, since some offer free drug programs for eligible patients.
Patients who have no, or limited, insurance coverage, may qualify to receive medication from the drug manufacturer’s pharmacy for free. Each manufacturer has their own income limit, guidelines, and individual applications for these programs. These applications usually require signatures from both the patient and the physician, as well as a proof of income document, such as a recent tax return, social security letter, or bank statement.