- Meet Consumers/Patients
|Newsletters: Insurance, Health Care Costs, and Your Finances|
Insurance, Health Care Costs, and Your FinancesOver the next few issues, we will be sharing resources and ideas related to finances and your personal health care—from organizations that offer help (as below), to details on how the Affordable Care Act might impact you (as details become known), to insights on Medicare. It’s a pretty broad topic. Please help us by sending your questions and sharing your experiences and tips to Lisa Metzger (email@example.com or 800-776-6539).
Patient Access Network
Patient Access Network (PAN) Foundation is dedicated to helping patients who would otherwise be unable to afford high-cost specialty medications. PAN provides financial assistance through more than fifty disease-specific programs designed to help patients being treated for certain cancers, chronic illnesses, and rare diseases.
A full list of PAN programs is available on their Web site. Of interest to many Oley members are the two PAN programs designed to benefit patients being treated for short bowel syndrome (SBS). The first provides co-pay assistance and another is dedicated to SBS patients who need financial assistance in order to pay for health insurance premiums.
PAN’s SBS Co-Pay Assistance Program provides qualifying patients with up to $10,000 to help pay out-of-pocket costs associated with prescribed specialty medications used to treat SBS. To qualify: patient must be insured; insurance must cover the medication; patient must be seeking assistance for a medication that treats SBS directly; patient must reside in and receive treatment in the U. S.; patient’s household income must fall at or below 500% of the Federal Poverty Level (about $77,000 for a two-person household). Currently, the two medications recognized as treating SBS directly are Zorptive® and Gattex®.
The PAN Foundation’s SBS Premium Assistance Program provides financial assistance for the patient’s portion of the premium associated with their insurance coverage (individual or family plan). Patients approved for the program can make the payments and be reimbursed by PAN or, depending on the employer and or payor situation, PAN can make the premium payments directly to the payor. Payment processes will be established as part of the approval process. To qualify, the patient: must be prescribed a specialty medication that treats SBS; must have access to insurance that covers this medication; and must reside in and receive treatment in the U. S. In addition, household income must fall at or below 500% of the Federal Poverty Level.
To apply, visit www.panfoundation.org or call (866) 316-7263; program staff are available 9 a.m.–5 p.m. (ET) Monday–Friday. PAN usually responds to a patient’s application within one business day. If a patient qualifies for assistance, PAN will send the patient an approval letter with information such as their award amount and eligibility dates. PAN will also notify the patient’s doctor and/or specialty pharmacy of the approval. If an application is not approved, PAN will contact the patient by phone to explain the decision. Approvals are for a twelve-month period, but they can be renewed if the patient remains eligible. PAN may also reimburse patients for qualifying medication expenses incurred up to ninety days prior to the patient’s approval date.
NeedyMeds is a national nonprofit organization that maintains a Web site of free information on programs that help patients who can’t afford medications and health care costs. The website, www.needymeds.org, has extensive lists of pharmaceutical patient assistance programs (PAPs); free, low-cost, or sliding-scale clinics; and drug discount coupons (as well as lists of scholarships and summer camps for people with special needs). The Web site also includes information about resources for specific diseases. All of the information is regularly updated, and accessible online at no charge and without registration. You can also call their hotline at (800) 503-6897. Representatives will help you identify the programs that may help you based on your medications and/or diagnosis.
NeedyMeds also provides a free drug discount card that offers a discount of up to 80 percent at more than 63,000 pharmacies nationwide. Anyone can use the card regardless of income level, residency, or insurance status, and no registration is required. The card never expires, and it can be used on all prescriptions (including prescribed over-the-counter medications and medical supplies), as well as pet medications. The discount card cannot be used in combination with insurance but it can be used instead of insurance if a medication is not covered, if you are in a coverage gap, or if you have a very high deductible or co-pay. You can request a NeedyMeds drug discount card through their Web site or hotline (see above).
Please also see the Tube Talk page on Prescription Hope, another possible source for discounted prescriptions.
LifelineLetter, September/October 2013