Financial Assistance Programs for Chemotherapy Medications and Treatment
About Financial Assistance
In recent years - new chemotherapy medications as well as supportive care medications
have become available. Some of these medications are available in pill forms
that are more convenient for patients. Unfortunately, the cost of these medications
can be great. Insurance coverage of these medications- that is, who covers
the costs of chemotherapy - is not always clear cut. For many
patients the medications may be covered at least partially under their insurance
company's prescription plan. Others have no prescription coverage and the
medications might be billed under the major medical portion of the insurance.
For some there is no coverage for prescription medications. The information
provided below offers some suggestions for help with this concern.
Check with your doctor's office:
See if they help to investigate your insurance coverage for chemotherapy medications
or if the pharmacy where you have the prescription filled checks this out for you.
Your insurance company may need documentation from your oncologist's office regarding
the need for the medication before it will be approved.
What if medications are not covered under insurance?
Most major drug companies have medication-assistance programs, which will provide
specific drug therapies at no cost to qualified, uninsured patients as part of their
commitment to charitable efforts.
The type of assistance varies from one company to another but most programs work
in a similar fashion. Information regarding the patient's medical insurance
status, income level and assets is needed. Most programs require that patients
do not have third-party prescription coverage.
Companies may need to see verifying statements from the doctor, which shows the
patient's need for the drug. Each company has their own application
forms asking for necessary information.
Your oncologist's office may have information
regarding some of these programs.
Types of drug assistance programs:
Some focus on helping to determine what the patient's insurance coverage for medications
and assistance with claim denials.
Some plans offer payment limitation programs
for very costly medications. Once patients reach the predetermined limit the company
will pay all other costs for the needed medication.
A few medication-assistance
programs retroactively reimburse costs for drugs that already have been dispensed
to patients. This way treatment is not delayed and patients are not charged
for medication that may have been administered prior to enrollment.