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If you are eligible, the programs below can help you afford . Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.
If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.
(Program 1 of 3. Scroll down to see them all.)
Provided by: HealthWell Foundation |
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PO Box 220410
Chantilly, VA 20153-0410
TEL: 800-675-8416 FAX: 800-282-7692 |
Languages Spoken: English, Others By Translation Service Program Website |
Medications |
Eligibility Requirements |
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Insurance Status |
May have insurance
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Those with Part D Eligible? | Yes | |
Income | Varies | |
Diagnosis/Medical Criteria | Medically appropriate condition/diagnosis | |
US Residency Required? | The patient must also be residing in the US. |
Application |
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Obtaining | Call or complete online | |
Receiving | Sent out or may be completed online | |
Returning | The completed application must be mailed back. | |
Doctor's Action | Complete section and sign | |
Applicant's Action | Complete section, sign, attach a copy of proof of income | |
Decision Communicated | Patient notified in writing | |
Decision Timeframe | 3-5 business days |
Medication |
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Amount/Supply | Not applicable | |
Sent To | Varies | |
Delivery Time | Not specified | |
Refill Process | Good for one year | |
Limit | Not specified | |
Re-application | New application every 12 months |
Additional Information |
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This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease.
Call for most recent medications as the list is subject to change.
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Updated 5/22/2017 |
(Program 2 of 3. Scroll down to see them all.)
Provided by: HealthWell Foundation |
|
PO Box 220410
Chantilly, VA 20153-0410
TEL: 800-675-8416 FAX: 800-282-7692 |
Languages Spoken: English, Others By Translation Service Program Website |
Medications |
Eligibility Requirements |
||
Insurance Status |
May have insurance
|
|
Those with Part D Eligible? | Yes | |
Income | Varies | |
Diagnosis/Medical Criteria | Medically appropriate condition/diagnosis | |
US Residency Required? | The patient must also be residing in the US. |
Application |
||
Obtaining | Call or complete online | |
Receiving | Sent out or may be completed online | |
Returning | The completed application must be mailed back. | |
Doctor's Action | Complete section and sign | |
Applicant's Action | Complete section, sign, attach a copy of proof of income | |
Decision Communicated | Patient notified in writing | |
Decision Timeframe | 3-5 business days |
Medication |
||
Amount/Supply | Not applicable | |
Sent To | Varies | |
Delivery Time | Not specified | |
Refill Process | Good for one year | |
Limit | Not specified | |
Re-application | New application every 12 months |
Additional Information |
|
This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease.
Call for most recent medications as the list is subject to change.
|
|
Updated 5/22/2017 |
(Program 3 of 3. Scroll down to see them all.)
Provided by: Patient Access Network Foundation |
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PO Box 221858
Charlotte, NC 28222-1858
TEL: 866-316-7263 FAX: 866-316-7261 |
Languages Spoken: English, Spanish, Others By Translation Service Program Website |
Medications |
Eligibility Requirements |
||
Insurance Status |
*See Additional Information section below
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|
Those with Part D Eligible? | Determined case by case | |
Income | Between 400-500% of FPL | |
Diagnosis/Medical Criteria | Medically appropriate condition/diagnosis | |
US Residency Required? | Must reside and receive treatment in US |
Application |
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Obtaining | Call or complete online | |
Receiving | Complete online or by phone | |
Returning | Complete online or by phone | |
Doctor's Action | Will be discussed with patient and Doctor after request is received | |
Applicant's Action | Call for information or inform doctor that he/she is in need | |
Decision Communicated | Patient and Doctor notified in writing | |
Decision Timeframe | Within 48 hours |
Medication |
||
Amount/Supply | Not applicable | |
Sent To | Patient sent card to be used at pharmacy | |
Delivery Time | Once approved; shipped same day | |
Refill Process | Patient presents voucher/card to pharmacy for each refill | |
Limit | None | |
Re-application | New application every 12 months |
Additional Information |
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*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.
Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.
Note: All new enrollment is now done electronically or over the phone. Contact program for details.
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Updated 6/29/2017 |