Note: This is a rough transcript of episode 27 of Health Savings News and has been lightly edited for clarity. It may not be in its final form.
Hello and welcome to Health Savings News, the podcast about healthcare costs in America and how to save money on the often expensive care all kinds of people need. I’m your host Evan O’Connor, joined by retired doctors Rich Sagall and Mike Woods. Each episode we discuss healthcare costs in America, offer tips for saving money, and relevant news that affects and reflects the expensive landscape of healthcare in America.
This week’s topic is patient assistance programs. Today we are exploring the various types of patient assistance programs on the NeedyMeds website. We have information on nearly 40,000 programs. All of the information is free and there is no registration sign up or enrollment. You can come to the website www.needymeds.org to find all the information you need and leave. If you have any questions or difficulties using the website, you can contact one of our knowledgeable counselors by calling our free help line at 1-800-503-6897.
Today we’ll start with a little bit of history about NeedyMeds and then get into the Patient Assistance programs. Back in 1997, when I was a family physician in Bangor, Maine, I was talking to a friend of mine, Libby Overly, who was a medical social worker in Mississippi. She was telling me about the program that provided free medication to people in need called Patient assistance programs. I thought I was socially aware, but I’d never heard of these programs before. Around the same time I had learned how to design and program websites. I thought this would be a fun use of my new skill and make a website that would be useful with the PAP information. Libby would provide the data and I would do the rest. She thought it was a good idea. So NeedyMeds was born. I have to give her credit for coming up with the name NeedyMeds. It’s served us well for over 25 years. NeedyMeds grew from a very part-time effort to what it is now, a nonprofit organization with nearly 30 employees helping 10 to 15,000 people every day on the website and handling three to 6,000 calls per month in our call center. Well, that’s enough history. Now we’re gonna get started with Kim Anderson, the manager of the PAP Research Department. I’m gonna be asking a few questions, Kim. first one, what exactly are PAPs, or Patient Assistance programs?
Hi Rich. First off, I just want to say thank you for inviting me today. I’m excited to be here. I’m super excited to be here today to talk about patient assistance programs or PAPs, and these are savings programs that are generally funded by pharmaceutical companies or pharmaceutical charitable foundations. These programs provide deeply discounted or even free brand name drugs to individuals that qualify. Unfortunately, not every brand name drug will have a PAP, but many do Needy meds currently. List close to 440 PAPs on our website, www.needymeds.org and new programs are added all the time, so it’s always a good idea to keep checking our website.
Do any of these programs cover generic medications?
Yes, some of the programs do offer PAPs for generic. Not quite as many as the brand name drugs, but there are some that do offer some generics. So just go to our website and type in the generic name of your drug and up will pop any program that might be available for it.
What’s the difference between a copay program or a copay card and a PAP?
Great question. Copays are usually for individuals with commercial insurance. The idea with these is to reduce the total out-of-pocket expense for the patient. So the insurance company will pay some of the cost, the drug manufacturer will pay part or in some cases all of the cost, leaving the rest to the patient. And what is left is usually a very small amount. Many drug websites provide the copay card and all the patient needs to do to sign up is go online and download a card. PAPs on the other hand, are generally for individuals with no insurance or who are under insured and are on a limited income. In most cases, eligible patients are able to get brand name drugs for free or for a very low cost. Almost all PAPs require that an enrollment application is filled out and signed by both the patient and their doctor. And there’s one other thing that I’d like to mention: Be sure when filling out the application, it’s completely filled out so that you don’t miss any checks or boxes. If not, it will only delay the process. So if you need help filling out the form, the program call centers have great people who are there to help you. So remember, you’re never alone when doing these.
What if there’s no PAP for the medication I’m on? Is there other help available?
Yeah, actually NeedyMeds.org has a ton of different avenues that you can go to. If you go to www.needymeds.org under the healthcare savings tab, many different savings programs are listed. You’ll find copays under the coupons, rebates and more section. You can also search by diagnosis or you’ll find additional programs related to a specific diagnosis. We also have a section on government healthcare programs, so be sure to check out that savings tab because there’s lots of programs that you may not have even considered, such as help with medical transportation costs or other types of savings. Also, if you’re on more than one medication, check to see if there’s a PAP for all the medications you’re on. Perhaps one of the lesser expensive medications that you have will have a PAP and it won’t be enough to free up your budget so that you can afford the more expensive medication that may not have a PAP. Another option is to ask your doctor if they can provide free samples. Many of the drug manufacturers have sample programs for healthcare providers. Another option is to ask your doctor if they can prescribe a generic if there’s one available. And finally, don’t forget the NeedyMeds Drug Discount card. That can save you up to 80% off the cash price of your medication. It can also save you 40% off medical equipment. So it’s a valuable card to have.
I know there are eligibility requirements for these programs. Can you tell me about them?
Sure. Most of the PAP’s eligibility requirements are based on three factors: insurance, residency, and income. If it looks like you don’t need the requirements, please apply anyway. For example, if you don’t fall within the income requirements, you may be able to ask for an economic hardship exception. Remember, it’s always better to try than to walk away.
The FPL, it stands for the Federal Poverty level and many of the programs income requirements are based on the federal poverty level. And NeedyMeds has a great feature on every single program page. It’s right next to the eligibility requirements and all you do is click on the link and fill out the questions asked. Remember when you’re filling in this out, not to add commas when you’re inputting your income and the results if in less than a second.
And it tells you where you fall on the federal poverty levels.
Can someone who’s not a US citizen apply to these programs?
Yes. Many of the programs only require that you’re a resident of the U.S. They do not require citizenship. So anybody who has a residency within the U.S. can apply for many of these programs. So check the PAP program page and it’ll let you know whether or not they require citizenship. Many of these programs are also available in our U.S. territories as well.
Does the person have to be a legal resident to qualify?
Not in all cases, no. Many times it just says U.S. residency is required. It doesn’t always say that you have to be a permanent resident, just that you have to be a resident and each program is different. So if you have any questions, call the program itself and talk to them.
What if I call the program and I don’t like the answer they give me?
Call back again and speak with somebody else because you may get another answer. Never, never give up. That’s all I can say.
Do I need to have a doctor to participate in these programs?
Yes. Almost all of the programs, in fact, I can’t think of any. They all require a doctor’s signature. You have to have a prescription from the doctor. So you really can’t even begin this process without having a doctor involved.
What if I don’t have a doctor?
I would call the program and talk to them to see what they have to say so that they can tell you next steps. And if they can’t give you a great answer, go to needymeds.org and look under the healthcare savings tab. And we have a full listing of free and low cost sliding scale clinics and there’s definitely one in your area that can help you.
I’d just like to add we have almost 19,000 thousand of these clinics listed. What if the applicant doesn’t speak English? Is that a problem?
No. Most of the programs have translation lines. So when you call, they can transfer you to somebody who speaks your native language. So it should never be an issue for you.
What should I do if my applications denied?
Appeal. Always appeal if your application is denied, when you apply to the program, a case manager will be assigned to you. So see if they can help you determine why you were denied. Did you completely fill out the application? If you missed something on the application, ask if you can resubmit. Was it something else? Find out what it was. And remember the program case manager wants to help you, so be sure to ask them for help.
Can I apply to more than one pap for the same medication?
Oh, absolutely. You can apply to as many PAPs as you’d like for the same medication. As I said earlier, if you’re on more than one medication, it may be the lesser expensive drugs that have the best discounts and will help free up your budget so you can afford all your medications.
If I have a question about the enrollment or the processing of my application, who do I call?
Always call the program unfortunately our NeedyMeds Call counselors, they’re fabulous, but they don’t know anything about your enrollment status. The only ones who know about your enrollment status are the people at the program themselves. If you can’t remember the program phone number, you can find it on the PAP program page on the NeedyMeds website. It’s listed at the top of the page. If you don’t have access to a computer, our Needy<eds call counselors can find them number for you and you can reach them at 1-800-503-6897.
How do I keep up with the changing information on these programs?
We actually have two different newsletters that you can subscribe to. One is called the Patient Assistance Program update service, also known as PAPUS. And the other is called the Diagnosis Assistance Program Update Service, also known as DAPUS. Both these reports can be found under the education tab on the NeedyMeds website. You can sign up to receive either one or both of the reports. You can have them send either daily or weekly. And these reports are fantastic because they give you the most up-to-date changes to our program pages and they’re really, really simple to read. They let you know about new and closed programs, drug additions and removals. They even let you know about application changes and eligibility changes. So I highly recommend subscribing to these.
Do the programs change often?
Yeah, they really do. The programs change quite often and they change for many different reasons. There can be a drug addition or a drug removal. The application could have changed, the eligibility requirements could have changed. So it’s a great idea to subscribe to either the PAPUS or the DAPUS because they inform you of these changes all the time.
How do you keep up with all this information? Over 400 programs must keep you quite busy.
Yeah, it does. <Laugh>, we divide the programs up so that they’re on a monthly schedule on when we update them and the first thing that we do is compare our website to the program’s website. We call the program to make sure that the information that we have is up to date and correct. We go line by line with every application to make sure that if it’s a minor change that we catch it and we have the most up-to-date application on our website. For some of these programs we have contacts that are from the program themselves who let us know about changes. So it keeps us quite busy. It’s a lot of fun though.
How do you find out when there’s a brand new program?
The first thing that we do every single day is look to see what new drugs have been released and approved. And then after that we go and check to see if there’s a program available and if there is, we add it to our website. Our whole goal is to be first to market with all of these new programs.
Thanks Kim. Here are a few pointers to keep in mind about applying the patient assistance programs. Remember, these programs are not just for poor people. No one would consider a family of four with a gross family income of $80,000 to be poor, but they would qualify for some of these programs. That’s why we recommend you look for all the programs for all the medications that you are taking. Also, remember, if you don’t like the answer you get when talking to a program counselor, hang up and call back. You’ll probably get a different person who may answer your question differently. And don’t forget to appeal any denials. The most common reason an application is denied is missing signatures. Make sure you sign every place you have to sign and you prescribe it as the same. Don’t forget to include all the supporting documentation that the program requires. Another important tip is don’t ask the prescriber to mail in your application. The prescriber’s obligation is to complete the appropriate sections on the form, not to mail it in by mailing it yourself. You have an opportunity to double check the form for completeness and accuracy. You know it was mailed if you do it yourself. And don’t forget to make the copy of every page to keep for your records.
Today we’re also joined by the NeedyMeds Database Research Manager, Damaris Mercedes Hernandez, who we affectionately call Dee. Thank you so much for joining us today, Dee.
Thank you for having me.
So what is your job specifically here at NeedyMeds?
Well, I am the database and research manager. Basically, I help maintain the information on the website. On a daily basis we research and make sure that we find programs that qualify to go on our website as well as doing daily updates on the databases that we maintain.
So many of the databases we have include diagnosis based assistance, coupons. We also have them for free and low cost clinics. Rich, as the founder of NeedyMeds, why did you decide to add the clinic information to NeedyMeds?
Back when we started NeedyMeds, all we had was the patient assistance program data and we would get calls from users saying that they meet all the qualifications or their eligibility requirements and the likelihood of the program, but they need someone to sign the application. They needed a physician to sign it and they’d ask me if I would do it. Obviously I couldn’t do it because they weren’t my patients. And that got us thinking about how we could help them find physicians. And one thing led to another and we started this database. It now contains 19,000 clinics, 19,000 plus.
So Dee, what types of clinics do we tend to list on NeedyMeds?
The clinics that we list are either free, low cost or have a sliding scale program. They consist of mostly federal qualified health centers, also known as FQHC, that are government run through Health Resources and Services Administration, which is also known as HRSA. We also list clinics that are private, nonprofit, tribal, faith-based, et cetera. As long as these clinics offer some type of financial assistance to low income uninsured, underinsured or underserved communities, we add them to our website.
Yeah. What types of centers qualify under the federally qualified health centers?
Well, we list community health centers. There’s migrant health centers, county regional health departments, public housing health centers, homeless shelter clinics, as well as school-based health centers, VA health centers, anything in that region.
What are the types of services provided by the federally qualified health centers and other clinics listed in the database?
The clinics we list offer many services including primary and preventive services. That includes medical care, dental care, mental health, substance abuse disorder. A lot of them provide telehealth services, mobile health and specialty services too. These services range from basic doctor visits to immunizations, health screenings, lab work, radiology, pharmacy, pediatric geriatric, men’s and women’s health, STD/HIV/AIDS services, as well as supportive services like transportation to and from the clinics, health education, referral services, medical supplies, free prescriptions, et cetera.
Wow. So it sounds like there’s a lot of services available that you’re describing virtually all of the medical care most people need. So based on that, what are the eligibility requirements that patients need to qualify to receive these types of services?
The best way to get that information is to contact the clinic directly, but most of them have their own set of requirements that are mostly based on but not limited to, income/insurance status, area residents, the community that they’re part of. And again, the patient should always contact the clinic directly for specifics.
We should also mention that NeedyMeds does not have any direct affiliation with these clinics. We’re just a listing of the clinics. What types of information does need meds collect on each of the clinics listed?
Of course, we collect the clinic’s name, the physical address, the contact information, which include the phone, fax, TTY number, email, website when those are available, the hours, the fees, eligibility requirements including income and insurance, services offered, area of service, and languages spoken are the main things that we collect.
About how many clinics do we have in the list
At the moment we have over 20,000 active clinics on our website.
And you are adding more all the time?
Yes, we research and add on a daily basis.
So with that many clinics on the list, how do you keep them all up to date?
Well, we do have a group of about six people that work in the database. And again, the clinics are set to be updated every six months. So our team is in there on a daily basis doing updates. Also finding new clinics as well.
With that many clinics how would a person find the right one for them?
The best way to go to buying the clinic that is best for you is to visit our website. Clicking on the healthcare savings tab there you can find the clinic section on the first row, select the type of clinic that you are looking for, whether it’s medical, dental, mental or substance abuse. Enter your ZIP code. You can also add your complete address for more specific directions or you can select from the state dropdown list. Once you have the list of clinics, review the eligibility and details and contact the clinic directly to schedule an appointment or additional information.
Apparently you can also put some conditions on your search, including how far you want to go to reach the clinic.
Yes. You can also put how many miles distance you are willing to travel or can travel.
We should also mention that if you think you may qualify, call the clinic. There is usually some flexibility and they may be able to help you even if you don’t quite need all of the eligibility requirements.
If you need assistance in navigating NeedyMeds or you have any questions or concerns or you’re having trouble navigating the, you can call our helpline, which is a one 800 number at 1 800-503-6897.
So where does NeedyMeds get all this information about the clinics that they list on your website?
Well, our main thing is, is doing research. Again, we do research on a daily basis. We have a team of about eight people, and we go adding them as they come along. Some clinics do contact us directly when they want to be added or if they believe that they can be added to our website.
How about if I find a clinic that you don’t have listed? What can I do at that point?
Well, you can contact us directly, give us the information. We will do the research and see if it does qualify to be on our website. And we,
Kim mentioned PAPUS, the daily or weekly email list that has all the changes we make in the pap data. It’s free and you can sign up forward on the website www.needymeds.org. In the menu bar at the top of the page, you’ll see the services tab. From there, you click on the subscription center and from there you can select which newsletters you wish to receive.
Here are a couple of other pointers to remember. When in doubt apply, you can’t lose by trying and you have a lot to gain by being accepted into the PAP. Another pointer, if your drug isn’t not a programmer or you don’t qualify, check back regularly. As Kim said, the programs change regularly. Finally, remember that all the information we have on all the programs is on our website. We don’t have any special information. If it’s not on the website, then we don’t have it. We have a number of ways you can learn how to use a NeedyMeds website. Carla, our director of education, has regular free webinars explaining how to get the most out of our website. Many are available on our YouTube channel, www.youtube.com/needymeds. And don’t forget, we have our toll-free helpline at 1-800-503-6897. We should also mention that all the information that people have at the helpline, all the counselors, it’s the same as what’s on the website. So there’s no clinics that we know about that are not on the website.
Thank you to both Dee and Kim for joining us for this episode. This is actually the last episode of Health Savings News for now. We are going to be going on hiatus. We’re gonna do some format changes, maybe change your release schedule, and we will be back in the future. Be sure to follow us on @HealthSavingPod on Twitter (for as long as Twitter stays around) to be aware of when we come back. Or just follow @NeedyMeds on Facebook, Mastodon, Instagram, LinkedIn, all the places.
To join Rich in shouting NeedyMeds Resources, you can find a wide variety of assistance relating to accessing abortion or gender affirming care and hundreds of other conditions in our Diagnosis Based Assistance section of needymeds.org under the healthcare savings tab.
Thank you so much for joining us for this episode and the past year of Health Savings News. You can still subscribe, rate, and review us on Apple Podcast or wherever you’re listening to the show — it still really helps. Our music is composed by Samuel Rulon Miller. His music can be found at musicisadirtyword.bandcamp.com. The Health Savings News podcast is produced by me, Evan O’Connor. All the sources we use in our research can be found in this episode’s podcast description on our website or your podcast of choice. Health Savings News is not intended to substitute professional medical, financial, or legal advice. Always seek the advice of a qualified healthcare professional or appropriate professional with any questions. Views expressed on Health Savings News are solely those of the individual expressing them. Any views expressed do not necessarily represent the views of Health Savings News, other contributors, the NeedyMeds organization or staff. Thank you again for listening. We’ll see you when we come back from our hiatus.