Medication Advocate provides the following services:

What is PAP?
What are the Eligibility Requirements?
What other documents are needed with the applications?
How soon can I receive my medication(s)?
Can I still apply if I have Medicare Part-D
Can my application be rejected?
Where do the medications come from?

What is PAP?

The Patient Assistance Program is a program that the pharmaceutical companies offer to help you with your medication if you cannot afford to pay for it. Medications include brand names and generics.

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What are the Eligibility Requirements?

Income:
To qualify for most patient assistance programs, your total household income must be less than 200% of the Federal Poverty Level. Some programs are 300% or lower.

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# of Persons in Family or Household 48 Contiguous States and D.C. Alaska Hawaii
1  $20,800  $26,000  $23,920
2  $28,000  $35,000  $32,200
3  $35,200  $44,000  $40,480
4  $42,400  $53,000  $48,760
5  $49,600  $62,000  $57,040
6  $56,800  $71,000  $65,320
7  $64,000  $80,000  $73,600
8  $71,200  $89,000  $81,880
For each additional person, add  $7,200  $9,000  $8,280

Prescription Coverage:
Prescription assistance programs require that you do not currently subscribe to private or public sources of prescription coverage or that your prescription coverage has reached its annual limit.

Residence:
You must be a United States resident or citizen to be eligible for any of these programs.

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What other documents are needed with the applications?

Most pharmaceutical companies require additional documents to be submitted along with your completed application. There are no set standards for what each company requests. Below you will find a list of the information most commonly requested by patient assistance programs.

  • Income:
    Many companies will request that you provide proof of income. The following are examples of acceptable material to submit for this request: Federal or State tax statements, pay stubs, or bank statements.
  • Coverage:
    As the general eligibility guidelines exclude applicants currently enrolled in prescription coverage programs, you may be required to provide insurance related information. The following are examples of acceptable material to submit for this request: current insurance plan statement, a rejection letter from Medicaid, or a rejection letter from an insurance company.
  • Physician Related:
    It may be required that your physician provide additional information besides what was requested on the enrollment form. In most cases, your physician will be required to provide a prescription for the specific medication, doctors information, or their signature.

Each company may request specific material from you in addition to your enrollment form. Please review the instructions we provided in each application packet before submitting your completed application.

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How soon can I receive my medication(s)?

After your enrollment application has been accepted to the patient assistance program, it usually takes 2-6 weeks before you start receiving your medication. Most pharmaceutical companies will ship the medication to your physician's office but on some occasions, medications may be shipped directly to you.

It is not guaranteed that you will be contacted if your enrollment form has been rejected. Make sure to save information detailed by the pharmaceutical company on how to check the status of your application.

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Can I still apply if I have Medicare Part-D?

Most patient assistance programs disqualify all those eligible for the full low income subsidy through Medicare Part D. If you do not qualify for the full low income subsidy, you should attach documentation to your application from Social Security Administration stating that you are ineligible. This information varies greatly between different companies and is subject to change without notice. It is not uncommon for exceptions to be made for those facing financial difficulties.

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Can my application be rejected?

Unfortunately not every application to a patient assistance program will be accepted. As these services are provided for free by the pharmaceutical companies, it is at their discretion who they reject and for what reason. It is unlikely that you will be disqualified for anything other than failing to meet all eligibility requirements.

It is possible to have the rejection overturned by submitting your application for appeal. You should request that your physician provide you with a letter of detailing under what circumstances your case should be reconsidered. After making copies of the material for your own record, send a fresh copy of your application, rejected application, and your physician's letter to the address listed for the patient assistance program with "ATTN: Appeals Department" on the front of the envelope.

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Where do the medications come from?

The medications are supplied and sent to you directly from the drug manufacturer and are normally filled for a 90 day supply.

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Eligibility Criteria - Patient assistance application : Patient Assistance Program Eligibility Criteria
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Patient assistance application, Patient Assistance Program Eligibility