For consumers who can’t afford to pay for medications, the struggle can be literally a matter of life or death.
The good news is, you don’t have to go without your meds. Help is available through major drug companies’ patient assistance programs.
These programs offer free or low-cost drugs to uninsured individuals who can’t afford their medications. Most brand-name drugs are found in these programs.
Each drug company has its own rules about who qualifies for its assistance program, but generally, you must be a U.S. citizen or legal resident, have no prescription drug coverage and meet certain income requirements.
“Generally, the income criteria will range from 200 percent of the federal poverty level to 400 percent of the federal poverty level, and there are instances where it could be higher,” said Tracy Foster, president of Lash Group, which administers patient assistance programs for pharmaceutical firms.
Recipients of Medicare’s Part D prescription drug benefit aren’t necessarily disqualified. In fact, most major drug companies have provisions for Medicare patients to qualify, Foster said.
“It is sometimes under a special program and may require a special application,” she said. “It sometimes requires that a patient already have spent a certain amount of money under their Medicare Part D benefit to qualify.”
Pfizer Inc. helps Medicare patients through “hardship exceptions,” said Gary Pelletier, director and team leader for Pfizer Helpful Answers, a group of programs that help the uninsured and underinsured get access to the company’s medicines for free or at a savings.
“They have to meet income eligibility criteria,” he said. “When they qualify for a hardship exception, we will give them the medicine for free through the end of the calendar year. We provide that entirely outside of the Medicare Part D benefit.”
The patient assistance programs can be of particular benefit to the millions of workers who have lost their jobs since the economic downturn.
Although it doesn’t collect employment data, Merck said its patient assistance program has seen a 50 percent increase in enrollees over the past three years, said spokeswoman Kelley Dougherty.
And Pfizer launched its MAINTAIN (Medicines Assistance for Those who Are In Need) program for the unemployed in 2009 “in response to the economic crisis,” Pelletier said.
“Many of the manufacturers have responded to increasing need by reassessing their income criteria,” Foster said. That has helped more patients qualify for assistance.
“Over the last three to five years,” she said, “we have seen manufacturers increase the [income] limit, so they’re accepting patients at higher-income levels and acknowledging that there are just greater financial hardships generally speaking, given the economy.”
Here’s what you need to know about these programs:
“Most of the applications for assistance need doctor participation,” Foster said. “It will also require a prescription or doctor’s signature saying the patient is actually being prescribed the medication they’re seeking help for.”
Make it as easy as possible for the doctor’s office.
Fill out as much of the application as you can. Highlight the directions for the doctor and where he or she needs to sign. Give the doctor’s office an addressed-and-stamped envelope to send in the application or highlight the fax number so it’s easy to find.
“A lot of times, it’s good to have a contact at the doctor’s office,” said Amy Zubrzycki, director of the Senior Prescription Assistance Program at the Senior Source, a Dallas-based nonprofit. “They can help speed up that information to the doctor, getting it signed and getting it back to you.”
Most programs have income criteria, and you must provide proof of income.
Plan ahead so your medicine supply doesn’t run out.
Call the patient assistance program if you have any questions.
Here are some sources of information on patient assistance programs and how to contact them:
• NeedyMeds is a nonprofit information resource that helps people in need find patient assistance programs. Go online to: www.needymeds.org.
• The Partnership for Prescription Assistance helps qualifying patients without prescription drug coverage get the medicines they need for free or nearly free. The PPA is sponsored by pharmaceutical research companies. Website is www.pparx.com or 1-888-477-2669.
• Extra Help is a program provided by Medicare to help those with limited resources and income pay for monthly premiums, annual deductibles and prescription co-payments related to a Medicare prescription drug plan. Website is www.ssa.gov/prescriptionhelp/ or 800-633-4227.
• RxAssist offers a comprehensive database of patient assistance programs and is part of the Center for Primary Care and Prevention at Memorial Hospital of Rhode Island. Go online to www.rxassist.org.
• Rx Outreach is a nonprofit organization that offers prescription medicines to uninsured individuals and families, as well as those who have limited prescription drug coverage. Go online to www.rxoutreach.org.
