Qualifying for free medication for expensive oral or infusion drugs is easier than most expect. In this article, we explore the eligibility requirements for PAPs and how QCSS can manage the entire process.
What is a Patient Assistance Program?
Patient Assistance Programs or PAPs are programs created by pharmaceutical manufacturers to help financially needy patients purchase necessary medications. The pharmaceutical company sponsors the program, and they help ensure that patients with low-to-moderate incomes, who are uninsured and underinsured, receive their medication at no cost. Each program is different, but they all require that the patient meet specific income guidelines.
Most patients are partially shielded from the high cost of medications through employer health insurance plans, Medicaid, or Medicare. Unfortunately, coverage gaps and formulary restrictions can financially burden even those with insurance. Uninsured patients or those without adequate prescription drug coverage will often pay for their medications out of pocket or not buy their medications due to a burdensome cost. Many are unaware of how PAP programs can help them receive their prescription without compiling vast amounts of medical debt in the process.
How to Qualify for PAP Programs
Eligibility and application requirements vary from program to program, which can sometimes make applying complex or confusing.
In general, you must meet the following requirements:
- Be a permanent, legal resident of the United States or Puerto Rico
- Prove you are uninsured or that your insurance does not cover your medication.
- Meet specific income eligibility requirements
What are the Income Requirements for PAP Programs?
Most PAP programs require the patient to fall within a specific Federal Poverty Level (FLP) to qualify for free medication. FPL is an income threshold that varies by family size. FPL outlines the estimated minimum income required for a household to buy food, clothing, and shelter. The requirements differ for each PAP manufacturer but generally range from 300%-600%. See the chart below:
As you can see, the income requirements for PAPs are incredibly reasonable and allow many patients to receive the financial assistance they need when paying for expensive medications
How to Apply to the PAP Programs?
The application process is extensive. The programs generally allow you to apply over the phone or online. They require the patient to submit proof of income and residency to prove eligibility – they will request a copy of the previous years’ taxes or employer paystubs. Additionally, the program requires your physician to complete and sign a form to finalize the application. Once the application and the requested documents are submitted, it can take between 7-10 business days to receive approval or denial. Following up with the program is key to a successful application process.
How Q Consulting Support Services Can Help
The eligibility and application process can be complicated and confusing for patients. Q Consulting Support Services (QCSS) can step in and relieve the burden from the patient and the provider’s office. We will facilitate and manage the entire PAP application process through approval and scheduling delivery of the medication. QCSS has an excellent team ready to alleviate your facility from this burden to ensure your patients receive the medicine they need.