Save Money on Health Care: Patient Assistance Programs

By Alden Smith

Medical Discount Plans - Dental Discount Plans - Prescription Discount Plans - Patient Assistance Programs - Health Savings Accounts

There is a movement in this country that many people are unaware of. Patient assistance programs offer assistance on prescription drugs for people with low incomes, who are unable to afford expensive medications. These programs are offered by the large pharmaceutical companies, and offer many benefits to people who are living at or below the poverty level, and have no prescription coverage. Even though the pharmaceuticals are not mandated by law to do this, they offer these programs to not only assist people in need, but to maintain good public relations.

The Need for Prescription Assistance

In the latest report from the Census Bureau, 46.6 million people in the Untied States were without insurance coverage of any kind. The Census Bureau also reports that this number has steadily increased over the past five reporting years. Many of these people are victims of the cost-driven decline in employer based health plans, and of the high cost of private insurance. This leaves many people with low incomes in declining health due to having to make the choice between basic survival needs such as housing and food, and the cost of needed prescription medicines they can ill afford.

Low income Medicare recipients without any type of drug coverage are especially prone to problems if they are ineligible for Medicaid drug assistance programs. Although states can pursue alternatives for these low income citizens through the Pharmacy Plus demonstrations, which expands the eligibility for Medicaid drug coverage, there are only four states that have approved waivers, and just 25 states provide pharmacy assistance programs. This leaves many without drug coverage of any kind.

The Medicare Prescription Drug, Improvement and Modernization Act, signed into law by President Bush on December 8, 2003, does provide some relief for these low income individuals. However, the need for a more comprehensive alternative is evident. The patient assistance program can help fill that gap.

How Patient Assistance Programs Work

To be eligible for one of the many prescription assistance programs provided by the pharmaceuticals, certain criteria must be in place. The person requiring assistance must of course meet income guidelines, and must have a prescription for the drug needed filled out by the issuing doctor. Generally, the person seeking assistance needs to be referred to the program by a doctor, or a clinic that is working with the individual on issues such as mental health. The needed forms may be acquired by the doctor or advocate through calling the pharmaceutical company. In addition, many of the needed forms can be found and downloaded for completion from RXassist.org. On this website, there is also a large list of companies offering prescription drug plans.

A list of things that may be required for eligibility are:

• Some type of proof of income, such as copies of W2 forms or pay stubs.
• Letters of denial, if any, from insurance companies or Medicaid.
• The required prescription from your doctor.
• Patient consent forms.

Many applications will request information about the physician, and may also require both the signature of the doctor and/or patient.

After submission of the required forms, the drug company will make its decision based on the eligibility of the patient. If eligible, the prescriptions may be sent to the patient's home, or to the prescribing doctor. In some cases, the prescription may be sent to the local pharmacy for filling and dispensing to the patient. At times, some companies may send a letter to the doctor and/or the patient, informing them of the company's decision on acceptance into their prescription assistance program. The drugs issued to the patient will be free of charge, or may require a small fee dependent on eligibility.

One of the best resources found during research for this article can be found by visiting the Partnership for Prescription Assistance at their website, www.pparx.org. Given here is a large list of more than 475 private and public participating companies and organizations, a comprehensive list of medications available, and even downloadable forms required for submission to the pharmaceutical drug companies. If Internet access is not available, they can be called toll free at 1-888-4PPA-NOW (477-2669).

Do these programs work? I am glad to report that yes, they are very beneficial to patients needing medications. In my work as a vocational rehabilitation counselor, I assisted a client in accessing the Pfizer Connection to Care program. This client was having many mental health issues, and as he lived well below the poverty level and had no insurance, he was in a position where he could not afford the psychotropic drugs that he needed to maintain a decent life style. I called Pfizer, they sent the required forms to me, and I had the client fill them out with the assistance of his physician. He received his medications in a very short period of time, and was able to get them refilled at no cost.

In researching this article, I found that this fine program is not well known. On the websites listed in the article, the authors list as reasons for this being lack of knowledge on the part of physicians, or the reluctance by clinics to fill out the required forms. Help is available. Searching the Internet with the keyword phrase "patient assistance program" will turn up a list of sites that can help those needing assistance in accessing these programs. There is really no reason for people to have to live without needed medications.

Medical Discount Plans - Dental Discount Plans - Prescription Discount Plans - Patient Assistance Programs - Health Savings Accounts

Alden Smith is an award winning author and regular contributor to DoItYourself.com. He writes on a variety of subjects, and excels in research.

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