Co-pay and Prescription Assistance Programs

For people with long-term medical conditions, the costs that come with doctor’s visits and out-of-pocket medication costs can be debilitating. It can feel overwhelming when you have to make payments towards coverage of a particular service or prescription. The good thing is that programs in place may help make your medication more affordable. Read on to learn more about co-pay assistance programs. 

Health Insurance Coverage Concerns

Adequate health insurance coverage is of utmost importance. This is even more important if you have a bleeding disorder or other condition that requires high-cost medication. While some coverage plans can provide some assistance with lower costs for certain prescriptions, this is only sometimes the case. You might also lack coverage due to switching to a new job or another set of circumstances. Regardless of the cause, lack of adequate healthcare can make it difficult or even impossible to pay for expensive medications, especially if it’s out of pocket.

Prescription Assistance Programs

Prescription Assistance Programs (PAPs) specifically help people who have no healthcare coverage or are underinsured. Specific entities like pharmaceutical companies and other agencies, including governmental efforts, usually provide these programs. If you are older than 65, Medicaid can also help cover these costs. PAPs offer services that are a welcome relief for many. Copay assistance for prescriptions can make all of the difference when you or a family member struggles to pay for necessary and often life-saving medications. Your doctor may or may not be familiar with PAPs, so research to see who might offer these services in your area.

Co-pay Assistance Programs

Almost all manufacturers of specialty high-cost medications offer co-pay assistance and other assistance programs. Mylyfe, or your specialty pharmacy, can usually set up an account for you with the manufacturer of the medication you use.  Once set up, the pharmacy can then bill the program for your out-of-pocket costs.  

Beware, some insurance companies tack on a co-pay accumulator adjuster to some plans.  These adjusters can be referred to by different names which can be confusing.  If your plan has an adjuster, the insurer will take the payment from the program, but will not deduct the amount from your total out-of-pocket contributions/payments.  A number of states have passed legislation banning co-pay accumulator adjusters. 

What Medications Are Covered

Many kinds of medications are covered under these programs, but not all of them. If you have questions about a specific medication, you can do a quick Google search to see if it’s likely to be covered under a PAPs program. You can also call the specific drug manufacturer to check potential coverage options. If they don’t have a PAP or co-pay assistance program, they may be able to point you in the direction of another program or agency.

How to Qualify

Only some qualify for copay assistance for prescriptions, but it’s worth looking into if you meet certain requirements. In general, some of the requirements to apply for financial aid include:

• Being a US Citizen or lawful permanent resident
• Ability to demonstrate proof of no healthcare insurance or low coverage
• Be under a specific income threshold
• Provide other documentation as needed

Unfortunately, to qualify for a co-pay assistance program, you cannot be on a public payor such as Medicaid or Medicare.  

With these programs, you might get only some medications for free. However, you may receive them at an affordable discount based on your eligibility. You also want to apply for coverage in these programs, as you won’t be automatically enrolled. You need to apply to these programs to know if you qualify. If you feel the burden of expensive co-payments, a prescription assistance program can help lift the burden. 

Mylyfe Specialty Pharmacy offers medication delivery services to people with medical conditions to improve their quality of life. Get started by emailing hello@mylyfe.health.