Patient Assistance Programs -vs- Foundations – Solving the Puzzle

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!

Patient Assistance Programs or Foundations

 What is the difference ?

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.

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.

Remember these organization will NEVER ask for payment information.

Medication Resources

PhRMA’s Medicine Assistance Tool Organization M.A.T.

PhRMA’s Medicine Assistance Tool (MAT) is a free SEARCH ENGINE designed to help patients, caregivers and health care providers learn more about the resources available through the various biopharmaceutical 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. Below is a link to their website along with a video about M.A.T

 http://www.mat.org

 

BIO Organization – Challenges during COVID-19

What patient assistance programs are available during COVID-19?

As the novel coronavirus continues to spread and create unprecedented challenges Bio.org put together a look at patient support programs available.

www.bio.org

Drugs.com

This website and app is a valuable tool. You can look up and identify medications, it lists all of the manufacturers of the drug and will directly connect you to their specific Patient Assistance Programs.

www.drugs.com

HealthWell Foundation

Our Mission: To reduce financial barriers to care for underinsured patients with chronic or life-altering diseases. This includes, copays, travel costs, pediatric and insurance premiums.

www.healthwellfoundation.org

fund finder

FundFinder now features a directory of more than 150 patient advocacy organizations that provide dedicated patient services including helplines, peer counseling, disease-specific education, and more.

https://fundfinder.panfoundation.org/Home/Index

PAN Foundation

We help underinsured 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 affordability.

http://www.panfoundation.org

Patient Advocate Foundation

Patient Advocate Foundation provides direct services to patients with chronic, life threatening and debilitating diseases to help access care and treatment recommended by their doctor.

www.patientadvocate.org

Patient Services Incorporated (PSI)

P.S I. provides help pay for your medication, provide health insurance premium and copay assistance, navigate health insurance plans, give legal advice, and be there every step of the way.

www.patientservicesinc.org

National Organization for Rare Disorder (NORD)

RareCare®

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

https://rarediseases.org/