Patient Drug Assistance Programs
Patient Drug Assistance Programs
Information for Patients of Midwest Heart Specialists
Illinoise Cares RX Plus:
Sponsor: State of Illinois
Annual: No annual fee
Eligibility Requirements:
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You have Medicare
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You are 65 years of age or older without Medicare
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You are a U.S. citizen or qualified noncitizen
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You are filing an application for yourself only and your total income is less than $27,066
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You are filing an application for yourself and your spouse or yourself and a Qualified Additional Resident and your total income is less than $36,560.
Benefit: If eligible, program covers almost all prescription drugs.
How to apply: Go to www.illinoisbenefits.org or www.illinoiscaresrx.com or call 1-800-252-8966
Miscellaneous information: Covers almost all prescription drugs and you must apply every year.
Illinoise Cares RX Basic:
Sponsor: State of Illinois
Annual: No annual fee
Eligibility Requirements:
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You do not have Medicare
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You are 16 years of age or older but under age 65 and totally disabled
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65 years of age or older and you do not meet the requirements for Illinois Cares Rx Plus
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You are filing an application for yourself only and your total income is less than $27,610; or You are filing an application for yourself and your spouse or yourself and a Qualified Additional Resident and your total income is less than $36,635.
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You are filing an application for yourself, your spouse and at least one Qualified Additional Resident, or yourself and at least two Qualified Additional Resident(s) and your total income is less than $45,657.
Benefit: Drug co-pays dependant upon amount spent throughout the year.
How to apply: Go to http://www.illinoisbenefits.org/ or http://www.illinoiscaresrx.com/ or www.illinoisdepartmentonaging.com call 1-800-252-8966
Miscellaneous information: Illinois Cares Rx Basic covers prescription drugs used in the treatment of Alzheimers disease, arthritis, cancer, diabetes, glaucoma, heart disease and its related conditions, lung disease and smoking-related illnesses, multiple sclerosis, osteoporosis and Parkinsons disease. Need to reapply every year.
RX for Illinois (Rx4 Illinois)
Sponsor: State of Illinois
Annual: No annual fee
Eligibility Requirements: A number of patient assistance programs provide help to patients who lack prescription drug coverage and earn less than 200% of the federal poverty level (approximately $19,000 for an individual or $31,000 for a family of three). Each patient assistance program has its own criteria. If you complete the step-by-step application process, you should be able to see if you are eligible for one or more programs.
Benefit: Free or discounted rates on medications vary depending on the assistance program you are enrolled with.
How to apply: Call 1-877-793-6745 or go to
Miscellaneous information: Patients will be directed to the public or private programs most likely to meet their needs. Rx4Illinois helps low-income, uninsured patients:
Enroll in more than 150 company patient assistance programs
Access more than 1,200 medicines for free or at a low cost
Learn how to contact government programs for which they may qualify, such as Medicaid, Medicare, or the State Children's Health Insurance Program
AstraZeneca:
Sponsor: AZ Medicine and ME
Annual: No annual fee
Eligibility Requirements:
You may be eligible if you meet the following criteria:
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You have an annual household income at or below:
$30,000 for a single person
$40,000 for a family of two
$50,000 for a family of three
$60,000 for a family of four
$70,000 for a family of five -
You do not receive prescription drug coverage under any private insurance or any other coverage that provides assistance to help pay for medicines, such as: Employer furnished or private prescription drug coverage, VA or Military Benefits, Medicaid, Medicare Part A, Medicare Part B (covers some injectable medicines), Medicare Part D
Benefit: You might be eligible to receive up to a 90-day AstraZeneca prescription at no cost, delivered to your home or physician’s office. Review the list of medication available through this program at
How to apply: Call 1-800-292-6363 or go to
Miscellaneous information: Must reapply annually
Aventis
Sponsor: Aventis Pharmaceuitcals
Annual: No annual fee
Eligibility Requirements:
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Patient must be a resident of the United States
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Patient cannot have or qualify for any government prescription coverage for Lovenox such as, Medicaid, Veteran's Administration, or any state or local program.
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Patient cannot have Medicare Part D prescription coverage. If the patient has Medicare Part D but is still having a problem affording their medication, please apply b/c sanofi-aventis may be able to help.
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Patient cannot have any private prescription drug coverage
Lovenox must be administered for outpatient use only -
You have an annual household income* at or below:
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$27,225 for a single person
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$36,775 for a family of two
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$46,325 for a family of four
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$55,875 for a family of four
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$65,425 for a family of five
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$74,975 for a family of six +
Benefit: Free or nearly free Aventis medications* shipped directly to the physicians office every 3 months.
Miscellaneous information: Patient and physician must complete form. Reapply each year. *For pt's. needing Lovenox, call Aventis directly at 1-888-632-8607
How to apply: Physician must call Aventis directly for application form. 1-800-996-6626.
Bristol-Myers Squibb
Sponsor: BMS Patient Assistance Foundation
Annual: No annual fee
Eligibility Requirements: U.S. citizen or Legal Resident alien. Based on total income, liquid assets, status of other drug benefits; must not have access to any prescription drug coverage; reapply every year.
Benefit: Free 12 month supply of medication. Covers 13 Bristol-Myers medications. 90-day supply shipped at a time.
How to apply: Call:1-800-736-0003 or go to www.bmspaf.org
Miscellaneous information: Medication is shipped to the health care provider; NPs with IL prescriptive authority can sign forms.
GSK Access
Sponsor: GkaxoSmithKline
Annual: No annual fee
Eligibility Requirements: Available to persons enrolled in Medicare Part D Drug Plan, have spent at least $600 this year on meds, reside in U.S. and have a total household income at or < then:
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1 less than $28,000
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2 less than $37,700
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3 less than $47,400
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4 less than $57,100
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*Annual household income amounts for Alaska and Hawaii are higher.
Benefit: GSK meds at no cost; drugs received from this program cannot be counted toward the Medicare "out-of-pocket spending"
How to apply: Call:1-866-518-4357 or go to www.GSK-Access.com
Lilly Cares
Sponsor: Lilly Cares Foundation
Annual: No annual fee
Eligibility Requirements: Eligibility is based on your inability to pay and the lack of third-party prescription payment assistance, such as insurance, Medicare, Medicaid, government, or community program. Basic eligibility requirements are as follows:
- You must be a U.S. resident
- Your income must be below certain levels, based on the number of people in the household (for example: $33,000 or less for one person, $44,000 for a family of two, or $67,000 for a family of four). Income limits depend on family size, and may be higher in Alaska and Hawaii.
- You must not have any other prescription drug coverage (private insurance, Medicaid, VA, Medicare Part D, etc).
Benefit: Most Lilly products are available through the program.
How to apply: Blank applications may be downloaded from this website, www.lillycares.com, or arrangements to receive an application by mail or fax may be made by calling 1-800-545-6962. The Lilly Cares program has a 12 month enrollment period for eligibile patients.
Miscellaneous information: Lilly Cares generally ships a 4-month supply of medication unless a lesser amount is requested by the prescriber. After the process of reviewing your complete application, your physician will receive your medications in approximately 3-4 weeks. Your prescriber will dispense your medication to you. The prescriber must request refills for you by using the Fax Refill Request Form, which is enclosed with each medication.
Merck Patient Assistance Program
Sponsor: Merck Pharmaceuticals
Annual: No fee
Eligibility Requirements: Available to residents of the U.S., who have no prescription coverage and are unable to pay for medications. Annual income limits:
<$43,320.single
<$58,280. per couple
<$88,200. family of four
Benefit: Eligible patients receive Merck manufactured medicines free of charge.
How to apply: Call: 1-800-727-5400 for information or an application form http://www.merck.com/
Miscellaneous Information: Prescription must be from a physician licensed in the U.S.
**If your income exceeds limits, yet you have special circumstances, your physician can request that an exception be made for you.**
Needy Meds:
Sponsor: Various pharmaceutical companies and private/public organizations
Annual: No fee
Eligibility Requirements: Varies depending on the program you are applying for.
Benefit: (PAPs) Programs which provide medicine at no cost or at a discount to people who qualify. Save up to 75% on prescriptions. Varies depending on the program you are applying for.
How to apply: Go to www.needymeds.org and type in the name of the medication you are looking for assistance with. If you are unable to locate the medication by brand or generic name there is not currently assistance available for it.
Miscellaneous Information: Must reapply annually
Novartis
Sponsor: Novartis Pharmaceuticals
Annual: No fee
Eligibility Requirements: Available to patients without drug prescription coverage. Must be U.S. resident. Income eligibility based on Federal Poverty Guidelines.
Benefit: Norvatis medications shipped to physician's office every 90 days.
How to apply: Call 1-800-245-5356 for information and an application form or visit www.PatientAssistanceNow.com
Miscellaneous Information: Must reapply annually
Partnership for Prescription Assistance
Sponsor: Various pharmaceutical companies and private/public organizations
Annual: No fee
Eligibility Requirements: Each program has different requirements. To find out which program best fits your needs you will need the name of your medications, your annual income, and type of prescription coverage.
Benefit: Reduced cost or free medications for more than 2,500 medications.
How to apply: Access to more than 475 patient assistance programs covering 2,500 prescription medicines.
Pfizer Pfriends
Sponsor: Pfizer Pharmaceutical
Annual: No Fee
Eligibility Requirements: Available to any legal U.S. resident without prescription drug coverage, regardless of age or income.
Benefit: You can save on most branded Pfizer medicines. Estimated savings range up to 15-36% and depend on such factors as the particular drug purchased, amount purchased, and the pharmacy where purchased. How to apply:
How to apply: Call 1-866-706-2400 for information or go to www.pfizerhelpfulanswers.com
Miscellaneous Information: More than 95% of retail pharmacies nationwide; mail-order service. Program available for individual drugs, check with the company. You must reapply each year.
Pfizer Connection-to-Care
Sponsor: Pfizer Pharmaceutical
Annual: No fee
Eligibility Requirements: Available to U.S. residents without prescription drug coverage or whom have Hardship Exceptions. Annual income limits:
- < $21,780 single
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<$29,420 couple
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<$37,060 family of three
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<$44,700 family of four
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<$52,340 family of five
Benefit: A 90-day supply of medicine will be shipped to your health care provider's office* for you to pick up, except Lyrica® (pregabalin), which will be shipped directly to your home. Prescription refills will be available during your 1-year enrollment period.
How to apply: Call: 1-866-706-2400 to request an application or go to www.pfizerhelpfulanswers.com
Miscellaneous Information:
Patient can obtain form, complete their section and ask their physician to complete remainder of the form.
Pfizer Maintain
Sponsor: Pfizer Pharmaceutical
Annual: No fee
Eligibility Requirements: Loss of employment since January 1,2009. Prescribes and taking a Pfizer medication for at least 3 months prior to becoming unemployed and enrolling in the program. Lack of prescription coverage and can attest to financial hardship.
Benefit: Enrolled patients will receive a 90 day supply of medication sent to their home and will continue to do so for up to one year or until they become insured, whichever happens first. Refills are available during the 1 year enrollment period.
How to apply: Can download an application at www.pfizerhelpfulanswers.com or by requesting it by calling 1-866-706-2400.
RSVP
Sponsor: Pfizer Pharmaceutical
Annual: No fee
Eligibility Requirements:
Benefit: The program offers reimbursement support services and patient assistance to help you gain access to the Pfizer specialty medicines you need. RSVP can also help you understand your coverage options and it can help you find other sources of funding if needed. If you have prescription drug coverage, RSVP can provide the following benefits:
- Reimbursement support services
- Research and confirm your benefits
- Explain coverage options and policies
- Investigate and explain prior authorization process
- Appeals process information
- Assistance with finding another funding source if necessary
- Hardship assistance, if you qualify
- If you are uninsured, RSVP also offers assistance. If you qualify, you may be able to get your Pfizer medicines for free.† An RSVP representative will help determine your eligibility.
To qualify for free medicines, you must:
- Meet specific income guidelines, adjusted for family size
- Live in the United States, the US Virgin Islands, or Puerto Rico
- Be treated by a licensed doctor in the United Stated or Puerto Rico
How to apply: Call 1-888-327-7787 for an application
Miscellaneous: Must reapply every 12 months. RSVP can arrange for the first supply of your medicine to be sent to your home or your doctor's office, depending on the medication.
Rx Outreach:
Sponsor: Express Scripts Specialty Distribution Services, Inc.
Annual: No enrollment fee, but there is an administrative fee for each prescription
Eligibility Requirements: Available to all U.S residents regardless of age or enrollment in other assistance programs. Annual income limits:
- < $32,490 single
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< $43,710 couple
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< $54,930 family of 3
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<$66,150 family of 4.
Benefit: Eligible patients receive free generic versions of brand-name medications (if generic available).
How to apply: Call 1-800-769-3880 for information
Miscellaneous Information: Apply each year. 90-day written prescription from physician; can have 3 refills as indicated by physician. Administrative fee: $20-40 per 90-day supply of each drug.
Together Rx Access (Prescriptions Savings Program)
Sponsor: Novartis, Abbot Laboratories, AstraZeneca, Aventis, Ortho-McNeil, Bristol-Myers Squibb Company, GlaxoSmithKline and Janssen.
Annual: No fee
Eligibility Requirements: Available to legal U.S. or Puerto Rico residents who are not Medicare eligible and not enrolled in a public or private program. No prescription coverage. Annual income at or below (income levels vary for Arkansas and Hawaii)
- $45,000/single
- $60,000/couple
- $75,000/ family of 3
- $90,000/ family of 4
- $105,000/family of 5
Benefit: A drug discount card that allows for 25-40% discount at participating pharmacies on select medications manufactured by the following drug companies: Novartis, Abbot Laboratories, AstraZeneca, Aventis, Ortho-McNeil, Bristol-Myers Squibb Company, GlaxoSmithKline and Janssen. Must not be eligible for Medicare or have any prescription drug coverage. Household income requirements are listed on website.
How to apply: Call 1-800-444-4106 to sign up for a card or go to www.togetherrxaccess.com
Miscellaneous Information: Can apply on-line for immediate approval
Works Cited
Medicare Prescription Drug Benefit:
Medicare Part D began in 2006. More information regarding this benefit is available at
Other web sites:
www2.caremark.com/naco
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