Prescription Assistance Program

If you don’t have health insurance or if your health insurance doesn’t cover your medication, a Prescription Assistance Program (PAP) might be able to help.

What are Prescription Assistance Programs?

Pharmaceutical companies create and run PAPs for some of the medications they make. You apply for a PAP for the specific medication you need directly through the pharmaceutical company that makes that medication. If someone qualifies and is approved for a PAP, the pharmaceutical company would send them one year of that medication for free. When the year is up, you can renew the PAP if you still qualify. 

How do I apply and do I qualify?

Since not every medication has a PAP you’ll have to check to see if the medication you need has a PAP available. Your doctor might also know if there’s a PAP for the medication you need, but you can also do an internet search for the name of the medication and “PAP.” If there’s a program, this search will lead you directly to the website and the application for it. 

The eligibility rules are different for every PAP. Usually, you have to be under a certain income limit or immigration status. Some applications will ask for a prescription and for your doctor to sign off on the application too. 

The applications are usually online, but some PAPs will ask you to fax or mail the application in. If you want to check up on the application, you can find the PAP specific customer service number on the PAP webpage. 

What if I don’t qualify or need more help?

If you’re denied or if there’s no program for a particular medication, talk to your doctor to see if there are any other options.

Some other options we suggest looking into: 

-Some Federally Qualified Health Centers (and Philadelphia city health centers) provide free or low-cost medications to their patients

-Ask your doctor about using a generic or different medication

-See if there are coupons from prescription coupon websites like GoodRX

-Check online pharmacies like Health Warehouse and RX Outreach to see if they have lower prices 

X Underinsured in this context = someone who needs medication not covered by insurance or doesn’t have prescription coverage

X Applications + meds distributed directly by pharmaceutical companies

X Google name of the medication and “PAP” which should lead you DIRECTLY to the site

X Process varies--some have online but some you have to fax or mail

X Need prescription, apps often need to be signed off by doctor, proof of income (tax returns, paystubs), letter explaining that you have no income, ID, some have citizenship reqs

Follow up if haven’t heard back about app in 2 weeks by calling customer service (PAP specific line, should be on PAP site)

Talk to your doctor if you can’t afford your medication, they might be able to tell you about PAP 

X If approved, you can get medication for a year, sent every 3 months, call when you need a refill 

If there’s no program for a particular medication or if you’re denied talk to doctor about getting a generic or a different medication or get coupons from GoodRX, check on online pharmacies (Health Warehouse, RX Outreach) -- can also appeal denials if you think they made a mistake in your income/with your info
 

CAO Letters

Some confusing letters! Don’t panic! 

Some types of letters: denials, approvals, notice to submit semi-annual report/renewal, they need more info/verification from you, changes to your benefits

Date mailed--important because you have a certain number of days from that date to take action

Case record number--identifies your case at the cao

Names--who is the CAO writing you about? You? Someone in your household? 

Action--what are they doing? Why? Look at words in bold!

Financial info at the bottom--a lot of the time, if they’re cutting you off or reducing your benefits, it’s because of an income issue. If this is the case, they’ll usually list out the income you’ve reported or that they’ve gotten from another source for you/other household members. Sometimes they get this wrong, so look at this carefully!

Appeal rights: 60 days to appeal a decision, ? days to ask for reconsideration of a denied application.

If you need help with this, contact PLA at 

Medical Bills

Look at the date of service, what insurance they have on file for you

If you can’t pay, see if they hospital has a charity care program. If they do, they might be able to cover some or all of the bill

Can also make a payment arrangement

Apply for MA?