Prescription Assistance Programs & Medicare Disability

Prescription drug sales in the United States are now running at more than $300 billion per year; prices and numbers of scripts continue to rise. For most Americans, the issue of assistance and/or insurance to help pay for drugs is one of the most basic. Patients with chronic conditions using specialty pharmaceuticals can face drug costs of thousands of dollars per month. For some, prescription assistance programs and Medicare coverage through disability may be relevant.

Prescription Assistance Programs--the Private Sector

• Most drug makers have prescription assistance programs.

  Many pharmaceutical companies have established programs to offer their drugs at reduced rates for those truly in need.

  Most companies require that the patient be without prescription or health insurance and live in a household with total income below the Federal Poverty Guideline. The limit varies by company and requires tax returns. A valid prescription and physician information are also required.

  Patients who can't afford their branded prescriptions can contact the industry's Partnership for Patient Assistance. Staff will send the applicant contact information, the forms and instructions for all the relevant pharmaceutical companies. Most, but not all, prescription drugs are currently available through these programs. Alternately, patients may look up drugs and find manufacturer applications individually through Needy Meds, a nonprofit website. Each drug company must be applied to separately. Acceptance is usually for a 12-month period. Annual renewals are usually possible; full reapplication with tax data is required.

  Please note: it often takes perseverance to gain acceptance. Many patients have experienced rejection because they sent in required information in the wrong order; applications can be discarded or mislaid by the company, yet the applicant is not informed.

  For those who are chronically ill and must take high-cost specialty pharmaceuticals, however, getting through the process may save thousands of dollars per year.

Prescription Assistance--the Public Sector

• Medicare supplements drug coverage through the Extra Help program.

  Those reaching 65 years of age with 40 quarters of taxable work income (or spouses of people meeting that criterion) will be eligible for Medicare. By selecting a traditional Medicare plan (with Part A and Part B), one may choose a Medicare Prescription Drug Plan (Part D). Alternately, if a Medicare Advantage Plan is chosen, drug coverage will usually come directly through that plan. In either case, there will be a monthly drug insurance premium and a co-pay for each prescription.

  Those with limited income/resources may qualify for Extra Help. If so, the monthly premium charged by most Medicare drug plans will be paid by the state. Extra Help also provides the patient with a flat co-pay rates for drugs. All branded drugs approved in the plan's drug list, will only require a co-pay of $6, as of 2010. Generic drugs require a co-payment of $2.50. Contact the state's Department of Children and Families.

Medicare and Disability

• In America, drug makers charge pharmacies full price, by law.

  The Extra Help program for prescription drug assistance may also be available before 65 if you become eligible for Medicare at an earlier age because of an accident or illness. If you develop a long-term disability and are unable to return to work, you may apply for official disability status under the rules of the Social Security Administration.

  Applicants may apply to their state's Department of Children and Families for disability status. Shortly after being judged disabled, the individual will begin receiving a monthly federal disability payment.

  Although health status may occasionally be reviewed, if the disability continues for two years from the date of the disability finding, the individual will be eligible for enrollment in Medicare and a Part D Medicare Drug Plan. An application to the state for Extra Help with drugs due to low income can be made, as it can by anyone on Medicare.