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.

Other resources:

• More information regarding pharmaceutical medications assistance programs often can be obtained from your doctor, pharmacists, nurses and social workers.
• The Internet also has sites from the various drug companies but there are also some general sites that may be helpful such as:
  • www.needymeds.com,
  • www.cancersupportivecare.com/drug_assistance.html, or
  • www.themedicineprogram.com.

  Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.
  

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