Prescription drugs can be the most expensive healthcare cost for many people. Those who are uninsured are typically stuck with paying full retail price for prescription drugs at the pharmacy counter, which can be hundreds or thousands of dollars per month. Even those who have health insurance - including Medicare, Medicaid and employer-based coverage - are often subject to significant out-of-pocket costs for prescription drugs. These "under-insured" folks might have to pay the full cost of drugs during a deductible period (or for Part D, the "donut hole"), and copayments can be significant.
There are some options to bring down the cost of prescription drugs even if you don't have health insurance, or even if your health insurance isn't paying the full cost. This article covers Patient Assistance Programs (PAPs) offered by drug manufacturers, and discount cards from a variety of sources.
Patient Assistance Programs (PAP)
Patient Assistance Programs (PAPs) are programs run by private pharmaceutical companies and health care providers that provide low cost or free prescription drugs to needy persons. Some provide drugs furnished by pharmacies, clinics, or hospitals. Some are run by pharmaceutical manufacturers or charities. Some provide prescription drugs to needy persons through a provider, others offer cash assistance directly to consumers.
The eligibility rules for each PAP are different. Most are limited to people with limited income, and some are also limited to people who are uninsured. Some will provide assistance to people whose primary insurance does not cover their drug at a particular time (e.g., during the Part D donut hole). If you have other health insurance and want to use a PAP, check with your insurance company to see how the PAP assistance will affect your insurance coverage.
PAPs and Part D
The Federal agency responsible for Medicare Part D has stated that the law does not prohibit PAPs from providing drug assistance to people enrolled in Part D. If a PAP provides free or discounted drugs during the deductible period, or in the coverage gap, the part of the cost of the drugs provided by the PAP may not be counted towards TrOOP. Only if the PAP provides cash assistance for the purchase of the drug, can this count toward TrOOP. See our Medicare Part D outline for more on TrOOP. PAPs may be a good solution for helping beneficiaries bridge the coverage gap.
To search for which PAPs cover your client’s drugs (and whether your client is eligible), visit the following websites:
Prescription Drug Discount Cards
There are many free discount cards out there that provide a discount on the full retail cost of prescription drugs. These cards are NOT the same as insurance! The way they work is a company, organization, or government entity pools lots of individuals together in order to negotiate discounts and rebates from prescription drug manufacturers. There may be limitations in terms of which drugs and pharmacies are covered. The plan passes on those savings to the members. However, the plan does not actually pay any part of the cost of the drugs. It's simply a discount off the full retail cost. In many cases, this discount can be quite significant (which only shows how inflated the full retail cost was in the first place!)
As with PAPs, these cards are most useful for people who have no insurance for drug coverage. For those with some insurance coverage, these cards may or may not help. They will not provide a discount of the insurance company's copayment. They might provide coverage during a deductible (or Part D donut hole). However, costs incurred during that period may not count towards getting out of the deductible or donut hole, so proceed with caution.
Here is a non-exhaustive list of some prescription drug discount cards. No endorsement, express or implicit, is intended by inclusion in this list:
The New York State budget for fiscal year 2015-2016 eliminated the New York Prescription Saver Program as of May 31,2015. It was a parmacy discount card program that began April 1, 2009 for NY residents who are not eligible for EPIC or Medicaid -- ages 50 to 65 and individuals with disabilities with incomes less than $35,000 per year and couples must have income less than $50,000 per year. See https://nyprescriptionsaver.fhsc.com. This article also explains how people with or without Medicare who are under 65 can use this card. Below are key concepts regarding operation of the program up to the discontinuation date May 31, 2015.
Applications: -- Effective immediately, new applications will no longer be accepted. The on-line application ability on the NYPS website has been disabled. The following message is displayed on the website: T The link from the DOH website to the NYPS website has also been disabled.
All Existing members may continue utilizing the program until May 31, 2015.
All claims transactions will receive the following message: As of 6/1/2015 NYPS claims will no longer be processed
There may be other prescription drug discount cards not included here.
This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.