What is a Patient Assistance Program?
A Patient Assistance Program, or PAP, is a program offered by drug manufacturers to provide access to medication to Americans who need but cannot afford them. Each drug company determines what the eligibility and enrollment guidelines will be for their free medications. These are the programs you may have heard about from Montel Williams.
Are the free drugs offered by the PAP generic medications?
No, they are almost always name-brand. The drug companies offer what they make - and they make brand name medications. These are the exact name-brand medications that are prescribed by your doctor and that you would pay full price for at your local pharmacy.
What if my doctor prescribed generic medications?
When you have been prescribed a generic medication that is not low cost and is not covered by a PAP, your doctor may be asked to substitute a name brand medication that is free or low cost. There are no programs for free generic medications. Some generic medications are available at a low cost at chain store pharmacies such as Target, Wal-Mart, Kmart and others.
What drugs are offered free on a PAP?
There are thousands of name brand drugs that are offered free on the PAPs. Our experience has been that over 95% of name-brand medications prescribed by doctors are available on a free program.
Are My Meds Available?
How and when will I receive the free medication?
Each PAP has determined how it will make its medications available to enrolled patients. Most medications are delivered to you in one of these 3 ways:
1. Mailed directly to your home or an address of your choice.
2. Delivered to your doctor to dispense to you without charge.
3. Dispensed at your local pharmacy at little or no cost when you use a 'pharmacy card' provided to you by a drug company.
Most PAPs will process your application and provide the medication you need within a few weeks of receiving your application. You can begin receiving free or low cost medication in as little as a few weeks of enrollment depending on 1) how quickly you and your doctor(s) provide the necessary information to Med Advocates and 2) the nature of the PAP.
What are the eligibility rules for enrolling in a PAP?
Each PAP sets its own eligibility guidelines. While they vary greatly in detail, they usually have these things in common:
1. Income based on number of people in the household and the sources of income.
2. US residency. Some PAPs require citizenship.
3. Lack of any other source for help with drug costs, such as prescription insurance, Medicaid, or state programs that cover prescriptions.
Do I qualify if:
1. I have health insurance, but no prescription insurance? Yes
2. I have prescription insurance but have received the annual maximum benefit? Yes, in most cases
3. I have Medicare Part D but have reached the 'gap' or 'donut hole'? Yes, there is help for those in the 'gap' of Medicare Part D.
4. My Federal 1040 income is too high, but I do not have as much income now? Yes, if you qualify on your current income.
What does Med Advocates do for me?
Med Advocates is the service that offers total management of the application process. When you choose Med Advocates, we collect necessary information from you to allow us to prepare applications for your medications, obtain prescriptions from your doctor, and send the completed applications to the drug company programs. We refill your prescriptions on a timely basis so you should never be without your medications. We re-enroll you in programs as needed to keep your meds coming.
Med Advocates Advantage
What if I am denied enrollment by the PAP?
If we have determined that you should qualify for a PAP based on the program guidelines, and you are denied enrollment, Med Advocates will file an appeal on your behalf. You simply need to forward the denial documents to us so we can proceed with the appeal. There is no additional cost for this service.
What are my responsibilities in the PAP process with Med Advocates?
Your responsibilities in order for Med Advocates to successfully manage your enrollment in PAPs include the following:
1. Promptly provide information and documents when requested;
2. Promptly provide information and documents from PAPs to Med Advocates when received;
3. Keep Med Advocates informed of address, phone number, doctor and prescription changes;
4. Keep your account with Med Advocates current.
What information does Med Advocates need to enroll me in a PAP?
Most programs require the following information:
1. Name, address, phone number
2. Date of birth
3. Social Security Number (or Federal ID number)
4. List of medication allergies
5. Income proof for the entire household
6. Number of people in the household supported by the income
7. Doctor's name, address and phone number
8. Each medication name, strength, dose and prescriber name
What does Med Advocates need for income proof for PAP enrollment?
The type of income proof depends on your income source and the PAP requirements for the medications you are taking. An advocate will discuss your situation with you and let you know what is needed.
Is there a cost for Med Advocates service?
Yes, there is a reasonable cost for our service, depending on the number of medications we are ordering for you. The cost is as follows:
Up to 5 medications $50 per month
6-8 medications $75 per month
9-15 medications $100 per month
16+ medications $150 per month
The monthly cost is not 'per medication' but a total monthly cost. For example, if we enroll you for 3 medications, you pay a total of $50 per month; if we enroll you for 5 medications, you pay a total of $50 per month. If we enroll you for 7 medications, you pay a total of $75 per month.
Unlike some PAP service companies, we do not charge for 'each' medication nor do we charge based on the amount you save. We do not charge a 'registration' fee, 'application' fee or 'membership' fee.
In 2008, our average client received free medications valued over $7,000 at retail cost.
Does Med Advocates charge any extra fees or costs other than the monthly enrollment cost?
We have no hidden fees or costs. Additional cost may be required only if:
1. The PAP requires a small co-payment for your medication. The vast majority of medications are free.
2. Your payment does not clear your bank.
How and when do I pay Med Advocates for PAP management?
We offer the following Easy Payment Options:
Automatic transfer from your bank account (savings or checking). If you choose this method, Med Advocates will not bill you until your applications have been sent to the PAP. Enrollment is month-to-month after the first 3 months, which is the minimum enrollment period.
Pre-payment of three months of service prior to work being done. Payments can be made by Money Order, Cashier's Check, or Credit Card (Visa, Mastercard or Discover). Enrollment is for the term of the pre-payment and no additional service will be performed until you make another payment.
5% Discount for Pre-payment of 6 months service
10% discount for Pre-payment of 12 months service
There are no refunds on pre-payment of services except as stated in Our Guarantee: If you do not qualify for enrollment in any PAPs based on the information provided by you, your payment will be promptly refunded. Med Advocates reserves the right to appeal denial of any applications prior to refund.
Can I terminate service with Med Advocates at any time?
Yes. When you enroll, there is a three month minimum enrollment because most medications are delivered in a 3-month supply. After the first three months, service can be terminated in writing at any time. With the monthly billing option through your bank account, your enrollment is month-to-month. With the pre-paid service option, your enrollment is for the duration of the pre-payment.
What if I make a prepayment and I never receive medications?
Our Guarantee: If you do not qualify for enrollment in any PAPs based on the information provided by you, your payment will be promptly refunded. Med Advocates reserves the right to appeal denial of any applications prior to refund.
Can I enroll in PAPs without Med Advocates?
Yes, many companies make their applications available to patients. Some drug companies require that a patient use an advocate to enroll in their program. Using our professional advocates to manage your enrollment in a PAP increases the chance of success and may decrease your frustration with the enrollment process.
What if I move?
Please immediately inform us of any change of address. Your timely notification will greatly reduce the chances of an interruption in service. We will take the necessary steps to update your address with each PAP in which you are enrolled.
The Patient Assistance Programs allow access to their medications throughout the United States as long as you have a doctor who is prescribing your medications.
How is my personal information protected?