What is prescription assistance?
Prescription assistance is help in paying for your or your child’s medications. Whether you are already receiving some insurance coverage for medications or you do not have any prescription drug coverage, there are programs to apply for and actions you can take if you struggle to pay for medications.
How do I know what my current insurance will cover for prescriptions?
The first step to getting help with the cost of your prescriptions is to understand your current prescription coverage. If you have private insurance, look at your health care insurance policy or summary plan description to find out if you have prescription coverage and what the conditions of the coverage are. Some insurance plans cover both medical care and prescriptions, and sometimes the medical care insurance plan may be separate from the prescription insurance plan.
If you are covered by public insurance (Medical Assistance, TEFRA, MinnesotaCare, or Medicare), then your insurance may or may not cover your medications. Call the customer service number on the back of your insurance card to ask for the conditions of your prescription coverage in writing.
The next step is to understand the conditions of your prescription insurance. Conditions within your plan might include: purchasing the generic rather than brand name medication unless specified by your physician, paying a set fee per medication or a percentage co-pay, annual caps or deductibles on medication costs, and/or coverage limits. Knowing these conditions can help you work with your doctor to lower the cost of medications.
How do I get prescription assistance?
Whether or not you have prescription insurance, it is important to talk to your doctor about how to lower the cost of prescriptions. Ask your doctor:
- If he or she has samples of the medication
- If he or she can prescribe the medication on a trial period or for samples if it is a new medication you are taking
- If he or she can prescribe the medication for a longer period of time so that you can buy the medication in a larger quantity, which might be cheaper (Even if you are taking a long-term medication, you can still ask your doctor for samples!)
- If you can try a generic or therapeutic alternative medication instead of the brand name medication
- If your physician has a connection with the drug manufacturer and can help in contacting the manufacturer about reducing the cost of the medication
- If he or she can write letters to your insurance company or to a Patient Assistance Program, to advocate on your behalf
- If he or she can help you fill out forms for applications to Patient Assistance Programs (Many of the applications require at least your doctor’s signature.)
In addition to working with your doctor, you can apply for prescription assistance through public insurance and/or Patient Assistant Programs. The Minnesota Department of Human Services has information on prescription assistance for people already enrolled in MN Health Care programs and has information on how to apply for MN Health Care programs.
Medicare Plan D is another public insurance plan option and is available to anyone currently receiving Medicare Plan A or B. Medicare Plan D has several different plan options, so make sure you understand the plan you select.
You also have the option of applying for Patient Assistance Programs.
What is a Patient Assistance Program (PAP)?
A Patient Assistance Programs (PAPs) are programs that offer free or reduced cost medications to low income, uninsured, or underinsured individuals. They are offered individually through the manufacturing companies that make and distribute the drugs.
What are the eligibility requirements for a PAP?
Eligibility requirements vary between PAPs. Some PAPs accept people who are insured or receive Medicare, and some require that you have no insurance. Check the eligibility requirements of the particular PAP before applying.
Where and how do I apply for a PAP?
Several websites and help lines now can assist you in finding and applying for PAPs. Check out the Resource Links at the bottom of the page to be directed to these websites. The Resource Link list is not an inclusive list of all online prescription assistance resources.
What is the difference between brand name, generic, and therapeutic alternative medications?
When medications are developed, they are given a brand name and a generic name. A manufacturer is given the patent for the brand name medication and is the only company allowed to sell that drug under that name. Brand name medications have patent protection for a certain amount of time.
A generic medication has the same active ingredients in the same quantities as the brand name drug, but is produced by other manufacturers after the brand name medication patent protection has run out. Competition among the manufacturers can then drive down the cost.
A therapeutic alternative medication has different chemical levels but the similar effects as the brand name or generic medications.
- MN Department of Human Services has information on prescription drug coverage for people enrolled in MN Health Care Programs, including lists of preferred drugs, drugs that require prior authorization, and drugs that require a diagnosis code. This website also provides links to information about how to fill out prescription claims forms.
- Rx Hope provides free assistance in finding and applying for PAPs. Many of the applications are online, and you, as a patient, can being the application process while Rx Hope helps coordinate with your physician to finish the application form.
- NeedyMeds allows users to search for PAPs by brand name, generic name, program or manufacturer name and links to other resources for prescription assistance.
- Partnership for Prescription Assistance offers free online or phone help in finding and applying for PAPs.
- Consumer Reports Best Buy Drugs provides consumer reports about drugs listed by name and condition, as well as money saving guide articles.
- Together Rx Access is a prescription drug discount card. The website gives you information about the card and an online application.
To learn more about prescription assistance, contact PACER’s Health Information Center at (952) 838-9000 or (800) 53-PACER, toll free in Minnesota.