“Free drug program” is the phrase often used to describe Prescription Assistance Programs, or PAPs—programs run by pharmaceutical companies that help qualifying American consumers acquire prescription medication. Sometimes PAPs cover a patient’s full drug costs, but in many cases they only provide a discount. Qualifying is not easy and there’s a lot of paperwork, but we’re supportive in exploring all useful options when it comes to affording medication.
Access
Consumers can find these programs through their doctors, pharmacists, community clinics, directly from the drug companies or on the Internet. There are three major sites which provide information on who can apply and how to take advantage of the benefits: www.rxassist.org (created by Volunteers in Health Care, a Brown University Center for Primary Care and Prevention resource), www.pparx.org (led, in part, by the Pharmaceutical Researchers and Manufacturers of America) which offers a useful eligibility screening questionnaire), and www.needymeds.org (which earns revenue though advertising and has a clickable map for national and local programs).
Eligibility
Eligibility is a complicated issue. Factors include income, assets, government aid, type of medication, and specific program applied for. Here are some key guidelines for eligibility:
The applicant:
- must be a U.S. citizen or a resident with a green card.
- must have a household income below $20,000 (individual), $26,000 (couple), $34,000 (family of three), $40,000 (family of four).
- may have an income higher than those listed above, though is without health insurance or drug coverage under current health insurance policy.
- have limited insurance, or is ineligible for private or public insurance all together.
- may be a Medicare beneficiary waiting for the next open enrollment period to Part D.
- may be enrolled in Medicare Part D but falls into the doughnut hole ($2,400 – 5,450 of prescription costs during one year) – Note: This is only true for some PAPs, many exclude this specific coverage. Also, the subsidy does not count toward your drug bills, so in using prescription assistance programs, you will delay getting out of the gap.
Despite eligible low-income, some patients may be denied, if:
- your assets exceed $15,000 – $20,000 and you can pay for your medicines on your own by using your savings.
- you are a Medicare beneficiary who has not yet enrolled in Part D (Low-income individuals can enroll at any time; they don’t need to wait for open enrollment).
- you are a Medicaid enrollee.
Concerns and Additional Hurdles
In addition to restrictions on eligibility, the heavy paperwork and a weighted application process make PAPs difficult to access. This paperwork is often only accessible online, and the demographic PAPs reach, the elderly and those with significantly low-income, may not have the technology know-how or resources to access the web. Additionally, critics claim that these programs, while useful, are very much a part of the marketing efforts of big drug companies: The PAPs allow a patient to start on a specific medication (often brand name) with the expectation that he or she will stay with that same drug once insured or in a better financial condition, making the free drug program a “loss leader.” But often the reality is that consumers lose their eligibility at a later date and simply cannot afford that same medication. Facing a growing public image problem, pharmaceutical companies also rely on PAP’s to improve their public relations.
We’ve spent considerable time trying to find out how many Americans actually receive free drugs from programs sponsored by the pharmaceutical industry but have come up empty handed. We do know that for those who qualify, PAPs are another lifeline for affording prescription medications. So if you’re having trouble or can’t afford medications and believe you are eligible, then you ought to apply for a free drug program.
