With the cost of prescription drugs skyrocketing, many patients find themselves worried about being able to afford their necessary medication.
Even with major medical insurance coverage or workers’ compensation after a work-related injury, medication can still be expensive and not all drugs may be covered. Luckily, there are several Patient Assistance programs that allow patients to get the medicine they need at heavily discounted rates.
Below, we answer some of the most commonly asked questions about Patient Assistance Programs as well as provide resources for patients in New York.
What is a Patient Assistance or Prescription Assistance Program?
A patient assistance program is a program created by a pharmaceutical company to help low-income patients afford their medications. These programs allow patients to get medications for a lower-rate or even for free in some instances.
Under a patient assistance program, you will often get your prescription sent directly to your doctor, or it may be sent to the pharmacy.
There are also many programs that are designed to give discounts at pharmacies after a medication is filled.
Some of these programs have no eligibility requirements, while some are meant to help specific patient groups, such as children or the elderly. Some of these are websites, such as GoodRx, that only require you to input your medication to get coupons that you can apply at pharmacies.
In addition, many pharmacies offer their own savings programs. Some major pharmacy chains offer generic medications at very low cost, without having to provide proof of insurance or any sort of discount. For example, Walmart Pharmacy has a list of low-cost generic medications that they offer to patients for only $4 for a 30-day supply.
How Do I Know if I Am Eligible for These Programs?
To apply for a patient assistance program through a pharmaceutical company, you must complete an application form that contains information about your medical history and your proof of income and that is signed by a doctor.
Not all medications manufactured by a company may qualify under a Patient Assistance Program, and each program will differ from company to company. To find out more about the eligibility requirements for a particular drug or pharmaceutical company, you can visit NeedyMeds for information. You can also obtain a drug discount card on the same website.
For other programs, there may be no eligibility requirements at all, such as a savings program at a pharmacy or a website that provides coupons for certain medications. For applications that require certain criteria, factors that influence eligibility may include:
- Amount of income.
- Proof of insurance or no insurance coverage (depending on the program).
- Medical history.
For a list of programs offered through the state and eligibility requirements, you can visit this website.
How Much Will I Save with Patient or Prescription Assistance?
New York offers a few prescription assistance resources for patients that help them get discounted or no-cost medications. These are programs offered by the state to help New York residents save on prescription medications. These programs include:
New York Rx Card. The New York Rx Card is a discount card offered to all residents of New York at no cost. There are no eligibility requirements other than being a New York resident and no applications. The New York Rx Card offers discounts of up to 75% off medications and can be used if a patient is uninsured, or to help pay for medicines that are not covered under an insurance plan.
Discounts are also available through the card for things such as hearing aids, prescription eyeglasses, and other medical supplies. To get a New York Rx Card, you can visit the New York Rx Card website.
BigAppleRx. BigAppleRx is the official no-cost discount card for prescriptions from the City of New York. It provides discounts on prescription medications, and there are no eligibility requirements. For more information or to obtain a BigAppleRx Card, visit the BigAppleRx website.
Child Health Plus. Child Health Plus is a children’s health insurance plan provided by the state of New York at no cost. To be eligible for this program, the child must be a resident of New York and under 19.
Child Health Plus is designed for children who do not have health insurance and whose family’s gross income does not qualify them for Medicaid. For more information about Medicaid or Child Health Plus, you can call (800) 698-4543.
Elderly Pharmaceutical Insurance Coverage (EPIC). EPIC is a program available to New York residents age 65 or older who make under a certain income. The income requirements for married elders are $50,000 or less. For single elders, the limit is $35,000. In addition, patients must have Medicare Part D and cannot have full benefits under Medicaid. For more information about EPIC, you can call (800) 332-3742.
Community Health Advocates. Community Health Advocates is not a prescription assistance program, but a counseling program that provides free advice to New York residents about affordable insurance programs and discounted care programs that can help patients save money on medications. To obtain free counseling over the phone, you can call (888) 614-5400.
For a list of prescription drug assistance programs and providers of counseling and information, you can visit this webpage.
Can I Get Prescription Assistance if I Have Insurance?
Depending on the program you choose, you may or may not be able to use these programs if you have health insurance coverage.
For certain Patient Assistance Programs offered through drug companies, or some state-sponsored prescription assistance programs, one of the criteria for joining is that a patient is uninsured and makes under a certain income amount.
However, some other programs, such as the New York Rx and BigAppleRx cards, are available to all New York residents regardless of whether they are insured.
These cards can be used to obtain discounts on medications that are not covered under a health insurance plan or when a deductible is still in effect under certain plans.
Savings plans at pharmacies are usually in effect regardless of whether you have insurance or not. This means the same low price for certain generic medications will apply with insurance or without. You can also use sites that offer coupons on medications to supplement your insurance coverage.
You can obtain information about what programs you are eligible for if you have insurance and how to maximize your savings by contacting a patient counseling program, such as Community Health Advocates, Partnership for Prescription Assistance, and RxHope.
Can I Use More Than One Prescription Assistance Resource?
For individual patient assistance or prescription assistance programs, you may only use one resource at a time. Most discount cards can only be used on their own, and may not be used in conjunction with insurance.
However, if you have a high copay or your medication is not covered under insurance, you can use a discount card instead of insurance to get lower-cost medicines.
You can also download coupons for medications to further discount medications you receive under specific Patient Assistance Programs.
Your local pharmacy or a counseling program can help you determine what discounts or savings you can use and how to get the lowest price for your medication.
Where Can I Get More Information About Prescription Assistance?
If you need more information about Patient Assistance Programs or other prescription resources, you can visit any of the websites mentioned above. You can also obtain free counseling over the phone to help you determine the best program and options for your needs.
Finally, if your physician has prescribed medication and you are worried about being able to afford it, ask your doctor if he or she recommends any resources for you. He or she may be able to help you get enrolled in a Patient Assistance Program or refer you to a resource that will help you afford the medications you need.
If you are one of the many patients who worries about the cost of prescription medications, rest assured that there is help out there for you. With the right program, you can make sure that you get the medication you and your family need without having to sacrifice other important expenses in your life.