What Patients Should Know About Qualifying For Co-Pay Assistance Through A Foundation
by Sandy Hope- Chronic Disease Fund Coordinator- Diplomat Specialty Pharmacy
In this article:
- Co-pay award is available for one year or until the amount is exhausted
- Diplomat recently expanded our funding department to assist as many patients as possible
- In addition to being diagnosis specific some foundations are diagnosis and drug specific
- Proof of income is a prerequisite and is generally satisfied through the submission of the patient’s most recent federal tax return
- The foundations are not designed to cover the total cost of the drug, but rather to cover the patient’s co-pay amount
It is a blessing to know there are several well established foundations dedicated to helping patients with the co-pay cost of their medicines. If qualified, the foundation provides a specified amount to be applied against a patient’s co-pay cost. This award is available for one year or until the amount is exhausted, whichever occurs first. The amount provided is most often based on the patient’s diagnosis. At Diplomat we put a lot of effort toward helping our patients obtain co-pay assistance through these foundations. In fact, we have recently expanded our funding department created for the purpose of reaching out to as many patients as possible to help them get the assistance they need to afford their medicine(s).
Each foundation has designated disease states or medical conditions that they support. Some diagnoses are represented by several foundations where others are only supported by one or two foundations making it more difficult to get funding for some medical conditions. We are continuously seeking out additional foundations and resources for our patients.
In addition to being diagnosis specific some foundations are diagnosis and drug specific. This means in order to qualify for funding the diagnosis and drug prescribed must both be supported by the foundation. As part of the application process the prescribing physician is required to complete and sign a section of the foundation’s application verifying the diagnosis and drug(s) prescribed.
Other guidelines of the foundations are similar in regard to the information each uses to determine a patient’s qualification. For instance, most consider the household size and income and have predetermined income schedules as part of their financial guidelines. To qualify, the household income cannot exceed the guidelines of the respective foundation. Proof of income is a prerequisite and is generally satisfied through the submission of the patient’s most recent federal tax return. If the patient is not required to file taxes, then he/she is asked to submit alternate documentation such as a copy of his/her (and spouse’s if applicable) social security award letter, a bank statement showing income deposits, and a pension statement if applicable. The documents are to be submitted along with the foundation’s respective application.
Another key factor in determining eligibility is the patient’s insurance coverage. The foundations are not designed to cover the total cost of the drug, but rather to cover the patient’s co-pay amount. For this reason patients are required to have Rx coverage or medical insurance that participates in the prescription cost. The foundations are aware of the pitfalls of Part D coverage and the gap period (donut-hole) a patient faces when taking costly medicines. Many foundations award enough to get patients through this period, but yet others do not and patients must seek additional funding. As part of the application process, the patient is required to provide copies of his/her insurance cards (front and back) for insurance verification purposes.
The above mentioned criteria (diagnosis, drug, household size and income, and insurance coverage) are the most common factors used by foundations to determine eligibility, but are not inclusive of the requirements established by each separate foundation. Our trained staff will help patients determine which foundation is best for them based on their particular circumstance.
Diplomat has also recently made enhancements to its website and the NeedyMed website now making it possible for patients, physicians or their staff, and others to complete an online application to Diplomat asking our help in seeking co-pay assistance. When completing this application the following information will be required: Patient’s Name, Date of Birth, Address, Social Security Number (optional) , Physician’s Name and Phone Number, Diagnosis, Drug(s) Prescribed, Household Size and Income, and Medical and Rx Insurance Information. The application can be accessed by going to https://www.diplomatpharmacy.com/funding. Upon receipt of the application, a Patient Care Coordinator will contact the submitter of the application to further qualify the patient for co-pay assistance through one of the foundations.
