Patient Assistance Programs That Help Save Money
Patient assistance programs help cut down on drug costs
Diabetes medications don’t come cheap. Based on a recent study of the cost of diabetes care, paying for the drugs and supplies you need to treat the disease runs more than $6,000 per year, on average. That can be a tremendous financial burden, especially if you don’t have adequate—or any—prescription drug coverage, or if you pay a good deal for your health insurance coverage.
There are resources, however, to help out. Pharmaceutical companies’ patient assistance programs can help you receive select drugs at no or lower cost if you meet their eligibility requirements. Guidelines vary from program to program, but in general, they’re based on your current health care coverage and your household income. If your health insurance includes prescription drug coverage that meets the cost of your medications or if your income exceeds the program’s limits, you may be unable to participate in the program.
Keep in mind: If you take medications from more than one drug manufacturer, you’ll need to complete separate applications for each program, and you may not qualify for all of them. For example, one pharmaceutical company might set its household income limit at 300 percent of the federal poverty level (about $75,000 for a family of four), while another might set it at 250 percent (about $63,000). You also will need to reapply annually to show that you’re still eligible. Some companies will consider your individual circumstances if you don’t meet their eligibility requirements.
To determine whether your income meets the eligibility requirements of your chosen program or programs, go to familiesusa.org/product/federal-poverty-guidelines.
Read on for some programs that can help you afford your diabetes drugs, then refer to the chart below for a list of covered meds and where to find more information.
AZ&Me Prescription Savings Program
You can get AstraZeneca’s diabetes medications for free through its AZ&Me prescription assistance program if you meet the following criteria: you live in the United States, Puerto Rico, or the U.S. Virgin Islands; your household income doesn’t exceed 300 percent of the federal poverty level; and you have no prescription drug coverage. One exception: If you are enrolled in Medicare Part D’s prescription drug program and spend at least 3 percent of your annual income on prescription medications, you may qualify for AstraZeneca’s program. But you must be able to show that you are not eligible for Medicare’s Low-Income Subsidy.
The GSK patient assistance program, GSKforyou, provides free medications to those who meet its eligibility requirements. Your household income can’t exceed 250 percent of the federal poverty level, and you can’t have prescription drug coverage. One exception: if you have drug coverage through Medicare Part D and you’ve already spent $600 on prescription drugs for the year. You must live in the United States or Puerto Rico to qualify.
Johnson & Johnson Patient Assistance Foundation
This program provides diabetes medications at no cost to people who live in the United States or any U.S. territory and whose household income doesn’t exceed 300 percent of the federal poverty level. If you already have prescription drug coverage, you’re ineligible for Johnson & Johnson’s program, unless you’re a Medicare Part D participant and spend 4 percent or more of your income on prescription drugs.
Lilly Diabetes Solution Center
Launched in 2018, Eli Lilly’s call center aims to reduce and cap out-of-pocket costs for people with diabetes who may not otherwise be able to afford their insulin. (If you were prescribed the drug Trulicity and don’t know how much it costs, visit lillypricinginfo.com to find out—and to learn of other resources that may help.) The company works with people on an individual basis to determine their needs and what options would best apply to them. The Solution Center, open to those who live in the United States or any of its territories, focuses on people who have no insurance or need help meeting their insurance plan’s deductible, as well as people with a lower income (no more than 400 percent above the federal poverty level). Among the options offered: price reductions when you purchase your meds and information about receiving free insulin through the Lilly Cares program (only residents of the United States and Puerto Rico are eligible for Lilly Cares). Beginning in March, the company will supply insulin to almost 150 free health clinics, each of which will establish its own qualification guidelines. Lilly’s Diabetes Solution Center will direct you to the clinic nearest you if you qualify.
Merck offers free diabetes medications if you meet these qualifications: you live in the United States or one of its territories, you don’t have insurance or other prescription coverage, and your household income doesn’t exceed 400 percent of the federal poverty level. Meet some, but not all, of these requirements? Don’t give up. Merck makes exceptions on a case-by-case basis, depending on circumstances such as financial or medical hardship.
Novo Nordisk Patient Assistance Program
If eligible, you can receive Novo Nordisk diabetes medications and other products, such as disposable needles, at no cost. To qualify, you must be a U.S. citizen or legal resident of the United States with a household income no higher than 300 percent of the federal poverty level. You may not participate in this program if you already have private prescription coverage, if you have or are eligible for public health care programs such as Medicaid and Medicare, or if you have prescription coverage through the Veterans Administration. There are exceptions, however, so check the program’s website (see chart below).
Pfizer Patient Assistance Program
Pfizer provides medications for free if you qualify for its program. To do so, you must live in the United States or one of its territories, and your household income must not exceed 400 percent of the federal poverty level. Having prescription drug coverage does not automatically disqualify you. If you have insurance but it does not provide sufficient coverage to pay for your meds, you may still be eligible for the program.
Sanofi Patient Connection
Sanofi offers its diabetes medications free of charge to those who qualify for its Patient Connection program. You must be a U.S. citizen living in the United States, Puerto Rico, or the U.S. Virgin Islands; have no health insurance that covers the prescribed medication; and have a household income that doesn’t exceed 250 percent of the federal poverty level. If you are eligible for Medicaid, you may not be eligible for Sanofi’s assistance program unless you have been denied coverage. However, if you are enrolled in Medicare Part D, you may qualify if your out-of-pocket costs exceed 5 percent of your household income. For example, if your household earns $20,000 a year, your out-of-pocket medication costs would have to be more than $1,000 in order to qualify.
Sanofi’s newest medication savings program offers insulin at a set discounted rate to anyone paying full price for a prescription. Through Valyou, you’ll pay $99 for a 10-milliliter vial of insulin and $149 for each pack of SoloStar insulin pens. Unlike many other prescription assistance programs, which aren’t open to people who have health insurance that covers prescription drugs, Valyou is open to those with and without insurance. People on Medicare or other federal or state programs aren’t eligible, however. You must be a resident of the United States, Puerto Rico, Guam, or the U.S. Virgin Islands to qualify.
Find a Program
Need help finding a patient assistanceprogram that’s right for you? The following can make it easier.
The Partnership for Prescription Assistance