Don’t Let Co-pay Costs Dictate Treatment Decisions

Even with commercial health insurance, co-pays and medication costs can run in the thousands of dollars—putting a financial strain on you and your family.  

Since added stress is certainly something you don’t need right now, we’ve compiled a list of tips and foundations to help you find financial assistance. 

Financial Counseling and Support

Before you do anything, see if there’s a financial counselor you can speak with at your cancer center.  Most clinics have financial counselors who will understand your specific situation and can help you make sense of healthcare expenses. Financial counselors can help you: 

  • Understand how much your insurance company will cover
  • Get a better idea of how much you’ll be responsible for paying
  • Develop a payment plan

Ask if your clinic has a social worker you can speak with as well.  A social worker may be able to direct you to foundations that can provide guidance on financial options, as well as emotional support. Some foundations also offer co-pay assistance programs and help covering medication costs. 

7 Tips When Applying for Co-Pay Assistance

  1. Plan to spend time, ideally before your chemo begins, planning your finances.  Include financial counselors and social workers in your planning if you can.

  2. Block time on your calendar to fill out applications.  Disclosing personal and financial information to a perfect stranger can be difficult, but it’s important for the submission process. Not including certain information could result in your request for financial assistance being denied. To make the application process quicker and easier, save the information you use in the first form as a template for future applications

  3. Get an online fax account if there are no businesses offering the service nearby. Though this seems outdated, many organizations still use fax machines to send and receive protected health information (PHI), because it’s HIPAA-approved.  There are online fax services like MetroFax offering free 30-day trials, which helps limit the expense of faxing documents.

  4. Co-pay assistance foundations have their own set of rules and work independently of any drug company.  Before applying, contact the foundation to find out if there are any restrictions or limitations.

  5. You can only receive support from one foundation at a time (for each diagnosis). However, if you have multiple diagnoses, you may be eligible for more than one grant. A grant is a form of financial support that doesn’t have to be repaid. If approved, you’ll likely receive a one-time grant that can be used for your co-pay, medication, homecare and travel expenses.

  6. Since the grants belong to you, it will be your responsibility to track the application deadlines, re-application deadlines and the grant balances.

  7. Eligible diagnoses and drugs covered change regularly, so it’s best to contact the foundations directly to see what’s available.


Co-Pay Assistance Foundations

Patient Access Network (PAN) Foundation: 1-866-376-7263

PAN provides co-payment assistance to patients who’ve had insurance but lack the means to pay the out-of-pocket costs for their medications or infusions.   

To be eligible, you must: 

  • Have health insurance covering your medication

CancerCare Co-Payment Assistance Foundation (CCAF): 1-800-813-4673

CCAF is a nonprofit helping patients afford co-pays for chemotherapy and targeted treatment drugs.  

To be eligible, you must: 

My Good Days Fund: 1-877-968-7233

Good Days’ mission is to ensure no one has to choose between getting the medication they need and affording the necessities of everyday living. 

To be eligible, you must:

Healthwell Foundation: 1-800-675-8416

Healthwell provides financial assistance to eligible individuals to cover co-insurance, co-pays, health care premiums and deductible for certain medications and therapies.  

To be eligible, you must: 

  • Have health insurance that covers your medication

Leukemia & Lymphoma Society: 1-877-557-2672

The Leukemia & Lymphoma Society Copay Assistance program is designed to help people who have been diagnosed with a blood cancer pay monthly insurance premiums and copays. The maximum grant amount ranges from $2,500-10,000 depending on the disease diagnosis. The program can also help you find additional sources of financial assistance if needed. 

To be eligible, you must:

  • Be a United States citizen or permanent resident of the U.S. or Puerto Rico
  • Have medical insurance and/or prescription insurance

National Association of Rare Disorders (NORD): 1-800-999-6673

NORD provides assistance to help patients obtain life-saving or sustaining medication they may not otherwise be able to afford.  

To be eligible, you must:

  • Live in the United States
  • Meet NORD’s financial criteria (determined by a discussion with the organization)

Patient Advocate Foundation (PAF), Co-Pay Relief: 1-866-512-3861 

Since 2004, PAF has provided financial assistance to qualified patients for prescription copayments. Their counselors work directly with patients, physicians and pharmacies to gather information and establish assistance as quickly as possible.

To be eligible, you must:

  • Be insured for the medication
  • Have a physician-confirmed diagnosis for the condition
  • Live in the United States

Drug Manufacturer’s Websites

Many drug manufacturers have Patient Assistance Programs for people who’ve been prescribed a therapy that they manufacture. You’ll have to visit the website of each drug manufacturer to see if they offer assistance, what kind of requirements are needed to qualify and how to apply. 

 

This material is furnished for informational purposes and is for your personal use only. It is not intended as a substitute for the expertise, judgment and specific advice of your doctor. Based on your condition and treatment plan, you may have different medical needs.