We know your treatment costs can add up. The good news is there are ways to help make them more affordable. One way is through Patient Assistance Programs (PAPs).
Make the most of Patient Assistance Programs
PAPs are offered through a pharmaceutical company or manufacturer (the company that makes your medications). PAPs are designed to cover some or all your prescription copay*. You’ll need to enroll in a PAP, and the pharmaceutical company or manufacturer will then decide if you qualify for the program based on things like:
- If you have commercial insurance
- If you use specialty products
- How much you make in a year (in some cases)
Find out which PAP may be right for you. To identify the name of the manufacturer, look at the drug or company name listed on your medication, usually on the box or on the vial (bottle). Then, visit the manufacturer’s website to learn more about available PAP programs and how to apply.
If you qualify for a PAP program, the pharmaceutical company or manufacturer will let you know. Your pharmacy will get the copay assistance card information and then submit the copay claims to the manufacturer. This will happen until you reach the maximum value through the program.
Make plans if you have copay accumulators
Your insurance plan may have a copay accumulator program. This limits the manufacturer’s portion of prescription costs from applying to your deductible and out-of-pocket maximum. So, if a manufacturer paid some or all your prescription copay through a qualifying PAP, what they paid may not count toward your deductible and out-of-pocket maximum. You should confirm with your insurance company how a PAPs impacts you.
Nearly half of Americans are enrolled in a high deductible health plan. Your plan may have a separate pharmacy and medical deductible. This means you may have higher out-of-pocket costs before your deductible is met.
Knowing if your plan has a copay accumulator program helps you plan ahead. You can set a budget. Or research more financial support options through nonprofit organizations.
Be your own best advocate. Below are some helpful tips:
- Read your insurance policy. Check if your plan limits or prevents what manufacturers cover from counting toward your deductible and out-of-pocket maximum.
- Prepare your questions in advance. It is your coverage. You have a responsibility and right to know your policy. You may ask:
- Does my policy have a copay accumulator?
- What is my deductible and out-of-pocket amounts? Do I have more than one deductible?
- Do you apply any of the copay assistance payments received to my deductible or out-of-pocket?
- Get answers. Contact your insurance or Human Resources representative if you have any questions.
- Clarify the policy with copay accumulator programs as needed.
We’re also here to help. Let your Coram®** pharmacy team know if you have applied for and are in a PAP program. This will allow us to support you better.
*Copayment, copay or coinsurance means the amount a plan member is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan.
**Coram CVS Specialty® Infusion Services
This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about your medical condition and prior to starting any new treatment. Coram assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result.
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