If you are in dire financial straits because you are unemployed or don’t have insurance, and if you can’t afford to pay for your prescription drugs, help is available.
Almost all of the major drug companies offer a patient assistance program in which your prescription drugs will be made available to you at a greatly reduced price or for free. You can check with the individual drug company, either by visiting the website or calling headquarters on the telephone, for more information. Also, ask your doctor to check with the pharmaceutical representative when he or she is in the office.
Here are some websites that can help, along with a summary of what the site does:
Pharmaceutical Research and Manufacturers of America (PhRMA) www.phrma.org. The website of the Pharmaceutical Research and Manufacturers of America (PhRMA) represents the country’s leading research-based pharmaceutical and biotechnology companies, which are devoted to inventing medicines that allow patients to live longer, healthier, and more productive lives. The industry invested more than $30 billion in 2001 in discovering and developing new medicines. PhRMA companies are leading the way in the search for new cures. PHRMA.org allows patients to link to various drug companies and see what drugs are covered by their patient assistance programs.
NeedyMeds www.needymeds.com. NeedyMeds is a portal for information about patient assistance programs and other programs designed to help those who can’t afford their medications. NeedyMeds is not a program, it’s an information source.
RXAssist www.rxassist.org. Assists patients in researching patient assistance programs through many different resources: federal programs, state Medicaid programs, state programs for seniors, the disabled or low-income, city, county and community programs, and drug discount cards.
Medicare Rights Center www.medicarerights.org. Information on state and private-assistance programs, mail-order discount pharmacies, internet based discount programs and prescription discount cards.
Medicare www.medicare.gov. Provides information on public and private programs that offer discounted or free medication.
Benefits Checkup www.benefitscheckup.org. Finds programs for people ages 55 and over that may pay for some of their costs of prescription drugs, health care, utilities, and other services.
STATE PHARMACEUTICAL ASSISTANCE PROGRAMS
State Pharmaceutical Assistance Programs offer financial assistance to people who have a serious illness, to help them pay for their medications. You (as the patient) are able to apply for these programs yourself. However, amounts and eligibility are different for each program. Also, please note: Each of these state programs listed below are only for the residents of that state.
Connecticut – CONN PACE Program
P.O. Box 5011
Hartford, CT 06102
(203) 678-1740, (800) 423-5026
Delaware – Nemours Health Clinic Program
1801 Rockland Road
Wilmington, DE 19803
(302) 651-4400, (800) 763-9326
Georgia – Georgia Cares
Senior Care www.seniorcareillinois.com
SeniorCare helps low-income seniors pay for most prescription drugs and many over-the-counter drugs if prescribed by their doctor. There is no enrollment fee but enrollees must reapply every year. SeniorCare is available to Illinois seniors age 65 years or older, unmarried with income of no more than $17,960 a year, or married with income of no more than $24,240 a year for both spouses.
SeniorCare pays up to $1,750 per person per year with either no co-payment or a low co-payment depending upon your income. After the $1,750 threshold is reached, you pay 20% of the cost of each prescription plus any applicable co-payments.
Apply by filing IL-1363 Application for Circuit Breaker and Prescription Coverage. You can get a copy from the Illinois Department of Revenue by calling the Forms Order Line toll-free at 1-800-356-6302 or writing to:
SeniorCare Illinois Department of Revenue
P.O. Box 19021
Springfield, IL 62794-9021
Illinois – Circuit Breaker Program
The Illinois Department of Revenue (1) administers the Circuit Breaker program that provides grants to senior citizens and disabled adults, (2) administers the Pharmaceutical Assistance Program that provides prescription medicines for seniors and disabled adults, and (3) enrolls individuals in the new SeniorCare program that provides expanded prescription coverage to eligible seniors
Illinois Pharmaceutical Assistance Program
P.O. Box 19021
Springfield, IL 62794
(217) 524-0435, (800) 624-2459
Maryland Pharmacy Assistance Program
P.O. Box 386
Baltimore, MD 21203
(410) 225-5394, (800) 492-1974
Michigan Emergency Pharmaceutical Program for Seniors (MEPPS)
P.O. Box 30676
Lansing, MI 48909-8176
Missouri – Community Leaders Assisting the Insured of Missouri
Pharmacy Prescription Program (CLAIM)
Pharmacy Assistance for Seniors
3425 Constitution Court, Ste E
Jefferson City, MO 65109
New Jersey PAAD Program
Pharmacy Assistance to the Aged and Disabled
P.O. Box 715
Trenton, NJ 08625
(609) 588-7049, (800) 792-9745
New York State Elderly Pharmaceutical Insurance Coverage (EPIC)
P.O. Box 15018
Albany, NY 12212-5018
(518) 452-3773, (800) 332-3742
Pennsylvania PACE Program (Pharm. Assist. Contract for the Elderly)
Pharmacy Assistance Contract for the Elderly
Rhode Island Pharmaceutical Assistance to the Elderly (RIPAE)
Department of Elderly Affairs
160 Pine Street
Providence, RI 02903
(401) 222-3330, (800) 322-2880
State of Maine Bureau of Taxation – Elderly Low Cost Drug Program
State House Station 24
Augusta, ME 04332
(207) 626-8475, (800) 773-7895, TDD (207) 287-4477
Vermont – VSCRIPT
State Pharmaceutical Assistance Program for Elderly & Disabled
103 S. Main Street
Waterbury, VT 05671
Drug company toll-free phone numbers:
Bristol-Meyers Squibb Company
Eli Lilly and Company
Pharmacia & Upjohn, Inc
Solvay Pharmaceuticals, Inc
(Source of data: PhRMA 1998 Directory of Prescription Drug Patient Assistance Programs)
Other Assistance Programs
Lilly Answers (877) 795-4559
Provides flat-fee prescriptions to people with Medicare.
The Medicine Program (573) 996-7300
Assists people in applying to multiple patient assistance programs.
Pfizer for Living Sharecard
Provides flat-fee prescriptions to people with Medicare.
Interactive Web site by PhRMA and 48 of its member companies designed to help you find patient assistance programs.
Un sitio Web interactivo que PhRMA y sus 48 empresas miembras ponen a su disposiciÃƒÂ³n. Este sitio fue diseÃƒÂ±ado para ayudarle a buscar programas de asistencia a pacientes que reunan los requisitos de elegibilidad.
State AIDS Drug Assistance Programs (ADAP):
Every state has an ADAP (AIDS drug assistance program). This federal program is administered by the grantee–the state. For example, if you live in Pennsylvania, the Special Pharmaceutical Benefits Program (SPBP) offers some 59 drugs to low to moderate income HIV-infected Pennsylvanians. Eligibility requirements were changed in January of 1995. The program is restricted to persons with an annual income of under $30,000 for singles. Families get an additional $2480 per child allowance when determining upper limit of income. For example, a family with two children could earn up to $35,000 and still be eligible for this free AIDS drugs program.
For Pennsylvania’s SPBP, contact John Folby of the SPBP (Dept of Public Welfare) at (800) 922-9384 or (717) 772-6057. He is very helpful on issues related to the Pennsylvania program. HRSA has not updated data since 1994! You might try contacting Margie DiClemente at (301) 443-9086 to see what HRSA can supply you on national ADAP program.
There are ADAP materials which Human Resources Services Administration (HRSA) compiles from time to time, but not reliably. Many of the resource materials in lieu of federally produced materials have been compiled by community members.
There are equivalent AIDS Drug Assistance Programs (ADAP) in other states. Call your state department of public health for information regarding your state’s ADAP program. The eligibility requirements as well as eligible drugs vary from state to state. The best community resource for ADAP information is AIDS Treatment and Data Network in NYC which compiles drug formularies and state-by-state regulations and posts it on their web page on the Internet at http://www.aidsnyc.org/network. ATDN, 611 Broadway, Suite 613, New York, NY 10012, (212) 260-8868, fax (212) 260-8869. Nationwide: (800) 734-7104. HRSA works with them to keep information updated.
Health Care Portability and Accountability Act
Health Insurance Portability and Accountability Act (HIPAA) was signed into federal law in 1996 Public Law 104-191. HIPAA requires the Secretary of the Department of Health and Human Services to adopt standards for electronic transactions, including data elements, standard code sets, unique health identifiers, security safeguards and privacy standards.
The primary intent and purpose of this law is to protect health insurance coverage for workers and their families when they change or lose their jobs. It was recognized that this new protection would impose additional administrative burdens on health care providers, payers and clearinghouses; and therefore, the law includes Section 262, Administrative Simplification. This section is specifically designed to reduce the administrative burden associated with the electronic transfer of health information between organizations, and more generally, to increase the efficiency and cost-effectiveness of the United States health care system. This approach accelerates the move from certain paper-based administrative and financial transactions to electronic transactions through the establishment of national standards.
Published: Aug 7, 2003