Prescription coverage is very important for cancer survivors. Yet, many people cannot afford prescription coverage and some go without prescribed medications and medical equipment. Fortunately, a variety of assistance programs are available to help people obtain free or reduced price prescriptions if they are not insured or are underinsured and cannot afford to pay. Knowing about these programs may lessen costs and help you get the prescription medication, devices or equipment that you need.
Prescription Assistance: Detailed Information
This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read Suggestions section for questions to ask and for more resources.
Prescription coverage is very important for cancer survivors. Without coverage, you may be responsible for the partial or full costs of prescribed medications, devices and equipment that are important to your health and recovery. Yet, many people cannot afford prescription coverage and some go without prescribed medications and medical aids. Fortunately, there are prescription assistance programs to help those who are not insured or are underinsured and cannot afford to pay.
Prescription assistance programs are available through a variety of resources. Federal and state benefit programs, nonprofit organizations and programs for people with cancer or disabilities provide services to help people meet their prescription needs. In addition, many pharmaceutical companies provide free or reduced-cost prescription medications to people who qualify for their programs.
Each prescription assistance program defines what is covered as well as the eligibility requirements. Knowing about these programs can help you get the medication, devices or equipment that you need if you have no prescription coverage. Even if you do have insurance, there may ways to lessen your costs for prescriptions.
This document provides an overview of the most common types of prescription assistance programs. It also discusses ways to get the best and most affordable help for your situation, including:
- Searching for prescription assistance programs
- Understanding different types of prescription assistance programs
- Lowering prescription costs if you have insurance
- Finding free or reduced-cost prescription services if you do not have insurance
- Qualifying and applying for prescription assistance programs
- Using caution with online prescription services
- Evaluating Internet prescription resources
Searching for Prescription Assistance Programs
Specific prescription assistance programs for your area can usually be found in a number of ways, such as:
- Contacting your area cancer organization or hospital and speaking with a patient services representative.
- Doing a search on the Internet using key words and the name of your community. For example, search for "nonprofit prescription assistance, Austin, TX."
- Checking the listings in the government or business sections of your local telephone directory.
- Talking with a helping professional, such as a social worker or a representative from the Department of Health and Human Services in your area.
- Calling the United Way 2-1-1 telephone helpline that is available in many areas.
Many nonprofit organizations will help you find prescription assistance programs and apply for benefits at no charge. There is usually no need to pay for services that provide this type of referral or information.
Other good sources of information about prescription assistance programs may come from:
- family members and friends
- hospital social workers, case managers, or other medical team members
- representatives from cancer organizations
LIVESTRONG SurvivorCare offers assistance to all cancer survivors, including the person diagnosed, caregivers, family and friends. The program provides education, information about treatment options and new treatments in development, counseling services and assistance with financial, employment or insurance issues.
To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations, including Patient Advocate Foundation and EmergingMed.
Understanding Different Types of Prescription Assistance Programs
Different types of prescription assistance programs may be available, including the following:
Categories of Programs
Types of Prescription Assistance Programs
Medicare prescription program (Part D)
Medicare is the national health insurance program for people ages 65 and older and for those with certain disabilities. Prescription coverage is now an option within the program, offering assistance to help pay for prescribed medications regardless of income or health care coverage.
Private and public prescription assistance programs
There are many public and private programs available, including:
- State Medicaid programs
- State and national programs for people with cancer, with disabilities and for the elderly
- City and county programs
- Nonprofit community programs
- Pharmaceutical company prescription assistance programs
- National nonprofit co-pay assistance programs
The following provides more specific information about different types of prescription assistance programs:
- Prescription medication discount cards are also called drug discount or drug savings cards. A discount card may enable you to save money off the retail price of certain prescription medications depending on where you live, the type of medication prescribed and the pharmacy that fills your prescriptions. Discount amounts vary by drug and card type, and there may be age or income restrictions.
Government agencies, various membership groups and nonprofit organizations have created prescription medication discount card programs. For-profit businesses may also offer prescription medication discount cards. Some discount prescription medication cards are free while others charge for enrollment as well as fees for daily, monthly or annual usage. Before you decide to use a card, be certain that you know about all costs that are involved and how much savings you will actually receive.
- Pharmaceutical company assistance programs generally offer free or low-cost prescription assistance for those who are unable to pay through Patient Assistance Programs (PAP). Most of the well-known pharmaceutical companies have a PAP, and each has its own criteria for eligibility. Some require that a doctor or other medical team member request the application form from the PAP program on your behalf. Discuss your situation with the PAP representative if you are not certain that you will qualify for services. Some programs will decide on a case-by-case basis in unusual or crisis situations.
The pharmaceutical industry has also established the Partnership for Prescription Assistance (PPA) program to work with pharmaceutical companies, physicians and other health care providers, patient advocacy organizations and community groups. PPA programs help people with financial need find public and private prescription assistance programs. If you want more information, contact the PPA program through their Web site.
- Health insurance programs for children: Many states offer low-cost or free health insurance for children from eligible families, and some will cover the parents for an additional fee.
Insure Kids Now! is a program sponsored by the U.S. Department of Health and Human Services (DHHS) to help families find health insurance for children. For little or no cost, the coverage includes payment for physician visits, prescription medicines and hospitalizations. Contact your state's program or go online to learn more about this program.
State Children's Health Insurance Program (S-CHIP) exists in most states to provide free or subsidized coverage for children (to age 19) from low-income families. Contact your local Medicaid office or the Centers for Medicare and Medicaid Services (CMS) for more information. In each state, the DHHS provides specific information about medical care assistance for families who meet low-income eligibility.
- Department of Veterans Affairs (VA): Most military veterans are eligible for medical care and prescription coverage through a local VA facility. Those who have service-connected medical conditions may be able to receive priority access to care. In addition, the TRICARE managed care medical program will provide health care services for eligible dependents. If you believe you might qualify for benefits, contact the VA in your area through their Web site or call their toll free number.
- Clinical trials: Clinical trials are studies to test treatments that are in development. These may include new methods of prevention, medications or combinations of medications, new surgical practices or other procedures to treat diseases and improve a patient's quality of life. Many hospitals participate in clinical trials after laboratory studies define the safety of a new treatment or procedure. One of the advantages to participating in a clinical trial is that patients often do not have to pay anything to participate.
Talk with your doctor about whether participation in a clinical trial would be a good way to obtain treatment. Two programs that will assist you if your doctor recommends clinical trial treatment are:
- LIVESTRONG Clinical Trials and Matching Service: The LIVESTRONG SurvivorCare program has partnered with EmergingMed to offer a free and confidential cancer clinical trial matching and referral service. The purpose is to increase treatment options for people with serious illness and to facilitate the development of medication options through the process of clinical trials. You can contact this program through the LIVESTRONG SurvivorCare program.
- National Cancer Institute (NCI): As a component of the National Institutes of Health, NCI conducts and supports research, training, health information and other programs related to the cause, diagnosis, prevention and treatment of cancer. Services also address rehabilitation from cancer as well as the continuing care and treatment options of cancer patients, including clinical trials.
Organizations that will assist you to find prescription assistance programs include:
- Access to Benefits Coalition (ABC): ABC is an association of more than 100 national nonprofit organizations. Members include programs that offer services for the aging, health care groups and other nonprofit organizations. This program works through local and state groups to help Medicare beneficiaries with limited incomes know about all available resources for getting prescriptions and reducing their costs.
- National Organization for Rare Disorders (NORD): NORD is an association of more than 130 nonprofit, voluntary health organizations that serve people with rare disorders. This program assists those who are uninsured or under-insured to get life-saving or life-sustaining medications by providing information on medication assistance programs, networking programs, a resource guide and links to other online resources. NORD's goal is to ensure that vital medications are available for those who have an income too high to qualify for Medicaid but too low to pay for their prescriptions.
- Needymeds.com: The Needymeds.com Web site provides information regarding patient assistance programs and other programs that assist with healthcare costs. The site includes direct links to the programs as well as the ability to download the applications for services.
- Patient Advocate Foundation (PAF): LIVESTRONG SurvivorCare program has partnered with PAF to provide information and referrals to co-pay relief and prescription assistance programs. The PAF Co-Pay Relief program provides direct co-payment assistance for pharmaceutical products to insured patients, including Medicare Part D beneficiaries who financially and medically qualify for services.
- RX Assist: The RX Assist program provides information on statewide drug assistance programs that are available for people who are disabled, have low incomes or are Medicare beneficiaries. Included are programs that provide coverage for Medicare Part D beneficiaries who are having financial difficulty due to a gap in coverage.
Lowering Prescription Costs If You Have Insurance
If prescription costs are creating financial stress for you, there may be ways to lower your costs. If you are insured, find out if your health insurance plan offers an option to order prescriptions by mail. Ordering prescriptions by mail may help you to save money by reducing the amount of your co-payment. Many plans allow you to obtain a three-month supply of your medication for what you usually have to pay a pharmacy for a two-month supply.
In an effort to reduce costs, you can talk with your doctor about whether there are nonprescription medications, generic options or other less expensive brands of the prescribed medication that would work as effectively for your condition. You can also find out if there are local pharmacies or state-licensed online pharmacies that offer the same prescription product at a lower price.
Some doctors routinely prescribe a specific brand of medication to treat specific health conditions. Certain brand name medications are more costly than others. In some cases, a generic brand may be much less expensive yet have the same active ingredients and work as well as the brand name medication. However, before making a change to generic medications, always discuss this option with your prescribing doctor as there may be other important factors to take into consideration.
If you are having difficulty paying for medications, discuss your situation with someone on your health care team. The social worker or nurse may be able to refer you to state-sponsored services and community assistance programs for help getting prescribed medications, devices or equipment. Family members, friends and other people on your health care team may also be able to help you find ways to pay for your prescriptions.
Certain hardships may make you eligible for prescription benefits through a prescription assistance program. A few programs will also offer help if you have insurance coverage, but are having difficulty affording the prescription co-payments. Common eligibility requirements for prescription assistance benefits include:
- You are insured, but have used the full limit of prescription insurance coverage
- You have no public or private prescription coverage
- Your income makes paying for prescriptions a hardship
- You do not have Medicaid coverage for the prescription
Finding Reduced-Cost Prescription Services If You Do Not Have Insurance
If you have no insurance, not enough prescription coverage or are not able to pay, you may be eligible for free or reduced-cost prescriptions. Many nonprofit programs, including some cancer organizations, offer free services to help those in need find resources and apply for prescription benefits.
Contact the U.S. Food and Drug Administration (FDA) for a list of resources and contact information for specific prescription assistance programs. The FDA also provides educational materials on topics such as ways to save money on prescriptions and how to safely use online services.
Qualifying and Applying for Prescription Assistance Programs
When you make your first contact with a prescription assistance program, ask about the eligibility requirements for their services. Some programs have specific standards, such as requiring that applicants be U.S. citizens or permanent residents, meet a certain income level, have limited assets or have no health insurance. Other programs might only ask that you get a referral from your doctor.
To qualify for low-cost or free prescription assistance programs, an applicant generally must do the following:
- Provide documentation that the high cost of prescriptions has caused a financial hardship for you.
- If you are not insured, provide a statement that you have no prescription insurance coverage.
- If you have prescription coverage, provide documentation that you have used all prescription medication benefits available to you, including all third-party insurance and coverage from Medicaid and social service agencies.
- If someone other than you has been paying for your prescriptions, such as a caregiver or family member, provide proof in the form of documentation.
When you apply for a prescription assistance program, let your doctor's office know what the program needs from them in order for you to qualify for benefits. For example, the program may require a phone call or letter from the doctor's office verifying your health condition and current medical needs.
Keep in mind that after your doctor agrees to provide medical information to the prescription assistance program, you need to follow up. Make certain that the necessary medical information is submitted within the timeframe the benefit program requires for eligibility.
If there is a delay in obtaining the required paperwork from your doctor's office, try bringing the program forms to a meeting with the doctor. If appropriate, fill in the general information portions of the form (such as your name and address) to make things easier for your doctor. If you need assistance getting the required medical information submitted to the benefit program on time, talk with one of your health care team members, such as a nurse or social worker.
After qualifying for a prescription assistance program, find out when services will start and whether delays are likely before you will begin receiving benefits. There may be a need to find a way to meet your prescription needs during any waiting period. For example, if you are waiting for prescription assistance, your doctor may be able to provide you with samples of the medication until the benefits start.
Using Caution with Online Prescription Services
Many people use the Internet to obtain their medications and other medical equipment. However, before you decide to fill your prescriptions online, check with your state Board of Pharmacy.
Some Web sites charge fees to help with the process of applying for and obtaining prescription benefits. In addition, some of these programs also charge a fee each time you purchase a prescription through their service. However, there is no need to pay for this type of assistance because there are many programs that do not charge for these services.
Before using an online prescription service, be aware of the following:
- To be legally valid, a prescription must be written by the medical professional with whom you have a doctor-patient relationship, such as your doctor or nurse practitioner. Avoid Web sites that appear willing to provide prescription medications without a prescription.
- Federal law prohibits buying controlled substances, such as narcotic pain relievers, sedatives, stimulants and anabolic steroids without a valid prescription from your doctor. Some Web sites may offer "cyber doctors" or those who write prescriptions for your use after you complete a questionnaire. However, the federal government does not consider this a legal prescription, and buying controlled substances this way could be punishable under federal law.
- If you decide to purchase medications online, the FDA recommends using medications only from online pharmacies licensed by your state and located in this country. This will help to ensure that you will only receive medications manufactured, packaged, labeled and distributed according to federal standards.
- A Web site may look as though it is operating as a licensed pharmacy when it is not. In many cases, medications come from Web sites for sources located in foreign countries. These products do not necessarily meet the safety standards set for prescriptions in this country.
- Purchasing prescription medications through Web sites that operate outside the law may increase dangers, such as side effects from the wrong medications, medication interactions and contaminated or impure medications. In addition to possibly being illegal, there can be significant risks involved in obtaining prescription medications through a Web site, including:
- Prescription products may be unapproved, misbranded, make false health claims and not provide adequate directions for use.
- Medications could be contaminated, outdated, too potent, not potent enough, counterfeit, improperly manufactured and potentially dangerous.
- If the wrong medication is received and taken, there could be a worsening of symptoms.
- The medications ordered and paid for might never be received.
- Delays in receiving the prescription medications could affect treatment or increase medical problems.
- Check with your doctor before buying any medical device or equipment and before using medical services advertised on the Internet. The FDA Web site provides information about whether a device is appropriate for home use and whether certain devices and equipment are FDA-approved for sale in this country. Be certain to research supply costs if you receive an offer of a free device. In some cases, the overall cost of supplies required to use that device may be more costly than if you had purchased another type.
- Selling certain medical devices or equipment without a prescription or a proper assessment by a health care professional is illegal. It is fraudulent to make untrue claims or sell medical services or products that are not FDA-approved. This includes certain medical equipment, machines, implants, test kits and other items used to diagnosis, heal, manage or prevent medical conditions.
Evaluating Internet Prescription Resources
The Internet can be a good source of information about services related to prescription assistance programs. However, some Web sites may be misleading about the sources of information used.
- Consider the source. Find out who sponsors the Web site and whether you might be looking at information presented by an individual, organization or retailer from another country. If the source is from outside the U.S., the products or services offered do not have to meet federal requirements or standards.
- Think about the purpose of the Web site. Consider why the Web site exists. The purpose of the Web site might be to educate, inform, sell a product or service, promote an idea, or to raise money. Each of these types of sites has a different motive, intention and way of presenting information.
- Find out where the information on the Web site came from. Good sources include sites sponsored by the government (.gov), those run by medical facilities or educational institutions (.edu), or sites sponsored by nonprofit groups intended to educate, provide service (.org), or share scientific writings (such as medical research). Commercial Web sites (.com) are often set up to sell a product or service and may have very different reasons for existing.
- Review Web site contact information. Contact information should be available for the sponsor of the Web site, including address, telephone numbers and names of people and/or departments within the organization.
Reporting Concerns about Online Services
Take the following actions if you have serious concerns or bad experiences with any health care products or services obtained online:
- If an online resource makes false claims about their services or products, notify the Federal Trade Commission.
- If you lose money using the Internet to make purchases, contact your credit card company, the office of your state attorney general and the Better Business Bureau.
- If the problem is serious, contact your doctor immediately. File complaints about adverse reactions or other serious matters with the Food and Drug Administration.
If you decide to work with a prescription assistance program, find out when services will start and whether significant delays are common before you can expect to begin receiving the benefits. You may need to find a way to meet your needs during any waiting period.
Many resources exist to ensure that prescription services are available and affordable for those who need them. Contact members of your health care team, a hospital social worker or a nonprofit group, such as a cancer organization, for help finding and evaluating prescription assistance programs and products.
This document was produced in collaboration with:
David S. Landay, Esq., author of Be Prepared: The Complete Financial, Legal and Practical Guide for Living with Cancer, HIV and Other Life-Challenging Conditions.
Weston, Liz Pulham. "A survival guide for the uninsured." MSN Money. 31 January 2007.
"Guide to Finding Health Insurance Coverage." Families USA for Cover the Uninsured Week: Let's Get America Covered. 2 February 2007. www.CoverTheUninsured.org
"Insurance Questions and Programs Offered to Cancer Survivors." Beyond the Cure. The National Cancer Society. 22 May 2006.
Landay, David S. Be Prepared: The Complete Financial, Legal and Practical Guide to Living with Cancer, HIV and Other Life-Challenging Conditions. New York: St. Martin's Press, 1998.
"Medical Insurance and Financial Assistance for the Cancer Patient." Cancer.org. American Cancer Society. 22 May 2006.
"Saving Money On Prescription Drugs." FDA Consumer Magazine. U.S. Food and Drug Administration. 9 January 2007.
"Use Caution Buying Medical Products Online." FDA Consumer Magazine. U.S. Food and Drug Administration. 8 February 2007.
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Prescription Assistance: Suggestions
The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information.
Identify ways you might be able to lower prescription costs.
Consider factors, such as:
- Does your doctor know of any effective options, such as nonprescription medications or different brands, including generic options?
- Are there state-sponsored services or community assistance programs that can help?
- Have you talked with a social worker or a cancer organization about programs that might help you get prescription coverage?
If you cannot afford to purchase your own health insurance policy with prescription coverage, check into other options. The Bureau of Primary Health Care Web site, sponsored by the Health Resources and Services Administration (HRSA) Information Center provides online services, publications, information, resources, and referrals about health care services for people who cannot afford care and/or are medically underserved.
Look into prescription assistance programs, including state Medicaid, state and national programs that help people with cancer and other disabilities, city, county and community programs.
Talk with your doctor about whether participation in a clinical trial might be a good way to treat your health condition. If your doctor recommends participation in a clinical trial, contact a program that will help you get in touch with the medical teams conducting clinical trials that are appropriate for you, such as through the National Cancer Institute (NCI) or LIVESTRONG SurvivorCare.
Find out if you qualify for help by contacting the prescription assistance programs directly.
If you decide to apply for benefits, be prepared to provide personal information, such as:
- Date of birth
- Current and last year's income and tax information
- Information about your health status
- Employment information
- Family information if you have a spouse, children or other dependents
- Citizenship or naturalization information
Identify options for coverage that are available through prescription assistance programs.
Find out specific information, such as:
- Are the medications you currently take covered?
- How much you might have to pay if your medications are not fully covered?
- If there is a limit to how much money the insurer will pay for medications?
- Will the program cover prescription devices and equipment if needed?
Complete all of the steps required by a prescription assistance program when you apply for benefits. Read all of the information the program provides about the application and qualification process for benefits. Ask questions if there is anything about the process that you do not understand. Follow each instruction carefully and submit all of the required documentation within the timeframe provided by the program.
Use caution when using the Internet for prescription services.
- Who runs and pays for the Web site?
- What is the purpose of the Web site?
- Is the information on the Web site reliable and where did it come from?
- Is there a way to contact a representative or sponsor of the Web site?
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