Getting Help with Cancer Drugs

When do cancer patients need help?

While you may or may not have insurance, there are times when you may need help with payment for your drug. Here are some times when that might happen. (Go directly to Drug Assistance Programs list.)

• When you have no insurance or have lost your insurance through a job change. If you have no coverage for the particular drug you are on or have no drug coverage at all, you should apply for assistance. Most of the drug companies have programs for their drug, particularly if it is a “brand name” drug. Use our Drug Assistance Programs to get the application and particulars for the drug or drugs that you are on.
• When you have no coverage for your particular drug. You may have coverage when your drug is given in the doctor’s office or hospital, but you have no prescription coverage. Or, you may have coverage for all drugs, but there is no coverage for your drug with your diagnosis. In both of these cases, you should apply for assistance. Click on the Drug Assistance Programs.
• When you think you cannot afford the out-of-pocket costs of your insurance. There is help for co-pays, premiums, deductibles, and other patient costs associated with cancer drugs. These are qualified by the particular cancer that you have. While all of these costs may not be covered, there may be some help for people with your diagnosis. Click on the Drug Assistance Programs.

What kind of help is available?

• For qualified patients, there is assistance with all aspects of drug payment. This means you can get qualified for “free” drugs, or you can find out if you are eligible for some other type of insurance. Qualification is based on your income and, in some cases, your medical expenses. There are some programs that may also ask you about your assets.
• For qualified patients, there may be help with the patient portion of your cancer drug bill. These programs are accessed by diagnosis and are available for patients in need. Bear in mind that most of the help for patients’ costs are for drugs that are given in your doctor’s office for cancer.
• For insured patients, lots of these programs will find out what your insurance covers. Cancer drugs can be expensive. So, it is good to find out each time you get a prescription if and how your insurance will pay.
• For many cancer drugs, all patients can call these programs at a toll-free number and find out about the costs for their drugs . This is a real service, which will cost you nothing and will give you financial peace of mind about your therapy or provide you with other alternatives.
• Many pharmaceutical companies provide free product samples to individual physicians or groups of physicians. Ask your doctor about the availability of free drug samples. You can learn more about the drug sampling programs of individual pharmaceutical companies by visiting their company websites.

What do I need to do to get help?

You need to be on a drug that has a patient program. We have two options you can look at—one for people who have no coverage (insurance) for their drug or think they might have no coverage and another for folks with trouble paying for their insurance’s share of cost.

• You need to provide financial and drug information. Most programs are based on federal poverty levels. This means you need to provide these programs with tax forms and/or bank statements that prove what your income is. They will figure out whether you qualify for their programs. Drug companies must establish that you are “in need” before providing assistance. The assistance will be drugs—not money.
• You need to fill out forms about your drug. In some programs, they want to know about your dose and other prescription information. In most cases, this is provided by the doctor. Some programs will ask you about all the drugs you take because they will subtract these from your income. This will make it easier to qualify.

What does it mean to be “in need”?

• Most programs use federal poverty levels by family size to qualify you for assistance. These poverty levels are a matter of public record and are on this page for your information. Most programs’ qualifying levels are not publicly available, but our experience tells us that they are set at 250 percent to 450 percent of federal poverty levels. Some programs adjust these for geography; some programs also have an asset qualification, which is described in more detail below.
• The Federal Poverty Guideline qualification is compared to your income as stated on your tax form. There may be adjustments for geography or extenuating circumstances in your finances as defined by the program.
• Some programs have an asset qualification. Assets are things like retirement funds, bonds, certificates of deposit, or vacation homes. They usually do not include your residence or car.
• Some programs will not cover you if they find insurance for you. Patients are always disappointed when they hear this, but the really good news about this is that insurance might cover your other medical costs.

How can I find out if I am “in need”?

• Check out our poverty level eligibility calculator. This will show you where you fall. Most programs will not cover you—depending on your medical expenses—if your household income is higher than 300 percent to 325 percent of federal poverty levels. That does not mean that you should definitely not call. Some of these programs might find other help for you. Additionally, they may know of other programs that you qualify for.
• Call the program by looking it up in our database (Help for Cancer Patients). You can look it up by drug name, brand name, or manufacturer. You can also find out some other information about the drug. There’s even an application there for some programs.
• File an application. Most of the time, you cannot file an application online. There is usually a requirement for a signature, but you can get an application through our website most of the time. You also should pull together your tax forms and/or pay stub.