Patient Assistance Program Application, How to Get it, Hints and Tips

Posted by Prescription Hope - See Editorial Guidelines (Last Updated On: Mon Jul 10 2023)

These days getting medications is not as easy as it sounds – or perhaps as easy as it should be. Especially with the increasing cost of living, not everyone may be able to afford health care equally. And not everyone may have medical coverage or health insurance that can support their prescription expenses. This is exactly where a PAP (patient assistance program) can help.

What Is a Patient Assistance Program? Patient Assistance Program commonly referred to as a PAP, is a program offered by pharmaceutical and medical supply manufacturers aimed at helping people who can’t afford health care to get their medications and supplies at zero or very low cost.

However, the process and eligibility requirements to get into this program will vary from one company to another.

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Pharmaceutical companies offer PAP’s with two main objectives. One is to establish a corporate social responsibility by helping people who can’t afford their meds. And the other one more towards a commercial aspect that is to use this as a good marketing tool for attracting customers.

So with that warm up on PAPs, let’s get into more details for you to get a clearer picture.

How Patient Assistance Programs Work

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As we said, all PAP’s are designed to help the needy with better medical support. This program has emerged in an effort to help patients who lack prescription drug coverage and health insurance to obtain the medications they need.

The very basic method by which this program works is by identifying customers who are unable to afford their medical expenses and providing them this program to comply with recommended drug regimens. This will thereby deliver financially unstable patients a better health outcome.

However, every pharmaceutical has its own guidelines, procedures, processes and other rules and regulations – which can differ. So the drugs included in the programs, eligibility criteria and how long a person can receive the assistance will be selected by the company.

Now, if you’re new to this and you’re wondering how to learn more about this, let’s read further.

Learn About Patient Assistance Programs

What might spring to mind when learning about this medical related program is obviously referring to your healthcare provider. But unfortunately, and surprisingly, many healthcare providers don’t even know there is a program that exists, mainly as it doesn’t form part of their core activities.

The best place to learn about PAP’s is by contacting us here at Prescription Hope to help you utilize and expedite the process of enrolling in patient assistance programs for the set price of $60.00 per month for each medication through our medication access service.

However, you may not find a detailed explanation of what this program is all about from just reading on the internet. You may find which pharmaceutical companies offer programs, and which do not provide programs and an overview of how their PAP works according to their procedures. But usually will not provide a complete consultation based on your specific circumstances.

It can be a complex process, certainly for someone not experienced in navigating the criteria around such an application, so the most convenient and reliable place to learn about this program is simply by contacting us so we can answer any questions you may have concerning eligibility and the overall enrollment process.

To put this in simple terms, below are some areas that could give you a good basic understanding of this whole program.

How To Get Medications Through PAP’s

patient assistance program

There are, of course, many pharmaceutical companies you can reach to enroll for a PAP. But as we mentioned, the overall approach to this program may vary from one to another.

However, one common requirement in any company that offers this program is to file an application form to enroll (will get more into this in detail below). The application form will require lots of information, which will also vary from one company to the next. Some patient assistance program applications may be online, but most are paper applications, which is why Prescription Hope’s medication access service will always be easier to help get your medications through PAP’s. We only have one online form, and from there we can enroll you into many different PAP programs.

These programs require patients to provide detailed medical and financial information.

Each PAP requires a healthcare provider’s signature to authorize the medication for the patient. Even under this, some companies require the healthcare provider to fill out certain information in the form as well. This is where Prescription Hope’s medication access service can help especially when taking into account any specific circumstances.

Some companies send the medication to your home, whereas some companies send the listed medications to the healthcare provider’s office for distributing them to their patients. Occasionally, some pharmaceutical companies will send the medication to your pharmacy. If one is getting medications from a pharmacy after enrolling into this specific patient assistance program, they may have to present a printed certificate or a card to the pharmacist.

While this all sounds great in getting enrolled in these programs, some patients who need to get ongoing medications may not be able to do so. This is because not all the programs that cover medications used to treat chronic diseases offer the option of refilling. You can see how this can quickly start to become complicated.

If this already sounds a little too complicated to understand, let us suggest an even better option to get enrolled into a PAP. The best thing for you to do is to enroll in Prescription Hope’s medication access service, offered here. Once we receive your application, we will see if you qualify for any existing patient assistance programs for the medication you applied for. If you qualify, we will reach out to you for income documentation and reach out to your healthcare provider for prescription information. Once we receive that back from you and your healthcare provider, we will then order the medication directly from the U.S. based pharmaceutical manufacturers patient assistance program that offers your medication. After the initial fill, we also place refills going forward so that you never run out of medication.

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Associated Costs In Patient Assistance Programs

PAP’s are programs for the financially needy and so there are no real negative costs in participating in this program.

The whole intention of Prescription Hope as a medication access service is to make the process easier for people who find it frustrating or confusing. Especially for adults and many elderly patients who may need our services for a smooth and easy process of getting your medications through PAP’s.

In fact, the convenience of a process like ours is worth it to ensure you have a partner who can walk you through the process smoothly.

With that, let’s take a look at the enrollment process. This can help you decide if you want to enroll by yourself or through Prescription Hope’s medication access service.

The Enrollment Process

Although there’s no standard enrollment process for every company, most of the PAP’s require the patient, healthcare provider or both to fill out an application form. Some pharmaceutical companies have a standard form applicable to all medical needs. Whereas some pharmaceutical companies require a separate application form for each drug. This is something we would handle completely, so you don’t have to worry about it when utilizing our service.

Most of the information and processes required for the enrollment process are stated in the relevant pharmaceutical companies’ websites. These, of course, vary from one company to another. Which is why it can sometimes be a difficult process to complete – certainly when applying for multiple drugs.

However, to provide a better understanding, below is some common information requested for the application process.

  • The patient’s information regarding the medical condition that needs assistance. The diagnosis of the medical need will have to be documented by the nurse, healthcare provider, treating physician or patient’s advocate.
  • The health and drug insurance coverage to show that the patient does not have prescription drug coverage. This will also confirm that the patient does not qualify for any other private or public health insurance (such as Medicare or Medicaid). In most of the PAP’s, patients who have health insurance and no prescription coverage is considered eligible for the program.
  • Patients with Medicare have different eligibility criteria, however, these patients should operate “outside the Part D benefit”. Some pharmaceutical companies offer this program to Medicare beneficiaries who don’t have supplemental drug coverage. Whereas some may deny the enrollment for patients with eligibility for other drug benefits from any public assistance program. This may include programs offered by the state and other local programs.
  • The enrollment process will also require the household income to be documented with a W-2 form, income tax returns and/or bank statements, for example. Once approved, the patient’s prescription medication is then sent to the provider’s office or a local pharmacy for the purpose of distribution.
  • All the patients enrolled under their program receives anywhere between a 30-180-day supply of their medication. In case patients require a re-fill, most of the PAP’s require them to submit a new application.
  • Keep in mind, these are just some of the basics of PAP’s and Prescription Hope has been managing the entire process for thousands of patients for over a decade, so we know our stuff.

You could enroll and let us see if your medication is covered or you might also want to know which medications are covered under the program. In fact, the whole purpose of the program is to get the medications that you need.

What Medications Are Covered

Of course, it is the pharmaceutical companies that decide if they need to have a PAP and they also decide what medications should be covered under it. Some companies include almost all of the medications they manufacture, whereas some offer only a few. Some companies also sell generic medications at a fixed price.

The programs also tend to add more drugs from time to time. But the availability of certain medications changes from available to not available from time to time. This means that certain dosage limits of meds could be available now and then off and then back on again. However, nobody knows the exact pattern these companies maintain or the reasons for their decisions.

Now that you pretty much know everything about PAP’s, it’s time to know the benefits of PAP’s.

Benefits Of Patient Assistance Programs

As we’ve already mentioned, each program has a different approach depending on the pharmaceutical company that provides their PAP’s. However, the following are some common benefits of a PAP from many pharmaceutical companies.

1) Coupons – These are discount coupons that patients can redeem directly with the pharmacy or the supplying company.

2) Direct discounts at your pharmacy – This is where patients enrolled under this program are able to get a direct discount from the pharmacy at the point of purchase.

3) Free product – This is where the supplies are directly shipped free of charge to the program participant.

However, these benefits as an overall can be limited based on the participating individual’s needs and resources. This is where some patients receive a full benefit of 100% discount on their medication. Whereas some patients may receive a 20% discount. Sometimes the PAP can also have its own timeline. This is where the processing and delivery of benefits can happen within one week or might even take several months.

Below we’ve compiled some hints and tips for you to use when enrolling into a patient assistance program.

Tips For Easy Enrollment

One of the most common problems a patient encounters when applying for this program is the lack of physician cooperation. Many patients have continuously faced physicians who couldn’t cooperate, which is understandable when you consider that patient care is their primary consideration, and form filling can often be low down on their priority list.

So in order to help overcome these complications, below are a few tips that may help you out.

  1.   Make sure you fill the form as fully as you can. Do not just limit it to the applicant’s section of the form, read it carefully so you understand it and see anything else you can fill in. This may include details like the physician’s name and address, phone number, etc.
  2.   Make sure you take with you all the documents the healthcare provider would require to fill in the form. This makes the signature process simpler for the healthcare provider. Some programs may require proof of income, identity and so on.
  3.   Bring an addressed envelope with the appropriate postage.
  4.   Give your healthcare provider some time to fill the form accurately.  A busy healthcare provider may not be able to fill the form immediately. In fact, your healthcare provider may not have the time to read and fill the form when you’re in the office. So make sure you give him or her sufficient time. 
  5.   If you experience a long delay or resistance from the healthcare provider. Present your needs and your financial condition, helping them understand why you need to enroll in the program. State that without his/her help you cannot enroll for the program and your health may suffer as a result.
  6.   If all your efforts fail in getting the healthcare provider signature, then you may have to find a physician who is more sympathetic. At least a healthcare provider who is willing to understand and authorized to help you out.
  7. Sign up. We can take care of the entire process for you, and all we require to get started is one simple online application.

However, remember that PAP’s are here to help financially unstable patients obtain a better quality of health through medical assistance. As such, your healthcare provider may need to make a fair assessment of whether or not to sign the forms.

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To Finish

We hope this has been useful in understanding more about the Patient Assistance Program and how they could help you, along with some hints and tips on how to navigate the process. However, by far the easiest way to deal with this process is to enroll . If you have any questions about saving money on your medications with us, or if you’re having trouble affording any of the medications you’ve been prescribed, contact us, or visit us online to learn more, we’re happy to help.