Specialty medications used to treat rare diseases, such as cancer, HIV, rheumatoid arthritis, hemophilia, or hepatitis C, are known for being extremely expensive. A large number of patients who rely on them simply cannot afford the treatments. Specialty pharmacy providers are aware of this and have in place a number of programs to mitigate the costs of these drugs. Providers first review the patient’s financial situation, and based on the patient’s income and the medication they are prescribed, they determine which program(s) they are able to offer.
If you are prescribed specialty drugs and cannot afford your out of pocket costs, several financial assistance programs may be offered to you.
Copayment Assistance Programs
Copayment assistance programs are usually available to patients who are insured. These programs are offered to every patient with insurance, regardless of financial situation, and can come in the form of a coupon or card from the drug manufacturer. Patients do not need to complete an application process in order to benefit from a copayment assistance program, making it an attractive option for those who are unable to afford their medication. However, copayment assistance programs are not offered in every state, or to those who are beneficiaries of a government-sponsored insurance plan such as Medicare, Medicaid, or Tricare.
Drug- or Company-Specific Patient Assistance Programs
These assistance programs are offered by pharmaceutical companies to uninsured patients who are having difficulty paying for their medication. Patients enrolled in patient assistance programs (PAPs) receive free or discounted drugs from the company itself. All PAPs offered by pharmaceutical companies have different enrollment criteria, but in order to benefit from one of these programs, patients typically must be U.S. residents, have no existing insurance plan, and fall below 200% of the federal poverty level. Some pharmaceutical companies allow government-insured patients to take part in their assistance programs.
Disease-Based Patient Assistance Programs
Disease-based patient assistance programs are available through non-profit groups who focus on helping people with certain rare diseases, such as cancer, that are financially draining. These programs are income-based, meaning only those who fall into a particular income bracket are eligible to benefit from them. A number of disease-based patient assistance programs are funded by pharmaceutical companies.
One downside of these programs is that financial assistance is not guaranteed throughout the patient’s treatment span. This means that the program can withhold funds at any time, and patients may be removed from the program at the non-profit group’s discretion. Additionally, patients enrolled in government-funded insurance plans are often excluded from participating in disease-based patient assistance programs.
If you think one of these programs is right for you, talk to your pharmacy provider about enrollment. They will provide an in-depth explanation on each financial assistance program, and guide you in the right direction.
Surya Singh, MD
Founding Medical Partner
Dr. Singh is actively licensed & board certified in internal medicine. He is currently the CEO of gWell, Inc, a genomics and wellness focused digital health company, and serves as a senior advisor and board member for mission aligned companies and non-profits. In addition, he is an Adjunct Instructor of Medicine at Harvard Medical School. He was formerly Corporate Vice-President and Chief Medical Officer of Specialty Pharmacy at CVS Health, and was an attending physician for many years at the Brigham and Women’s Hospital in Boston.