Last Updated: January 2005

Q. Why do many patients with health coverage need additional help to pay for prescription drugs?

A. Many health insurance plans, as well as traditional fee-for-service Medicare, do not cover the cost of prescription drugs. Other plans limit the number or total cost of prescriptions they will pay for. Many limit you to a list (formulary) of particular medications they will pay for, favoring cheaper drugs over more expensive drugs.

Q. What can uninsured patients, as well as patients without enough prescription coverage, do to get help to pay for medication?

A. There are sources of help with the cost of prescription drugs, whether or not the patient has insurance:

• ADAP (AIDS Drug Assistance Program): pays for medicine for some low-income people with HIV infection.
• EPIC (Elder Pharmaceutical Insurance Coverage): is a prescription plan for low-income elderly people. EPIC covers almost all prescription medicine, insulin, and insulin syringes sold at participating pharmacies. Members pay a small share of the cost of their medications, and people with lower incomes pay a smaller share.
• Patient assistance programs: are offered by some drug manufacturers. These drug companies give away some of the medications they produce to low-income people, but they don’t advertise this, and they may have a waiting list.
  

Q. What kind of help is provided by ADAP (the AIDS Drug Assistance Program)?

A. ADAP is a prescription plan that pays for medicine for some low-income people with HIV infection. Even if a person has prescription drug coverage through other health insurance, that plan may not cover all the expensive drugs that are necessary to treat HIV infection and AIDS. Many insurance policies have limits (“caps”) on the number or total value of prescriptions, and they also may exclude essential medications from their list of approved drugs.

ADAP requires no membership fees or drug co-payments. However, it only covers drugs used for HIV/AIDS and certain related conditions.

To qualify for ADAP, a person must not have more than $44,000 in annual income and $25,000 in assets (not counting the value of a home or a car). Additional income is permitted if there are additional household members. Proof of income and assets is required as part of the application. To obtain ADAP information and applications, call 1-800-542-2437 or TDD (518) 459-0121, or write to HIV Uninsured Care Programs, Empire Station, PO Box 2052, Albany, NY 12220-2052.

Q. What kind of help is provided by EPIC (Elder Pharmaceutical Insurance Coverage)?

A. EPIC is a prescription plan that is open to people aged 65 and over who have incomes of $35,000 or less if single, $50,000 or less if married, and who do not qualify for Medicaid or other coverage that's better than EPIC. These limits are higher than they were before January 1, 2001, so some people whose income used to be too high are now able to join EPIC.

The plan covers almost all prescription medicine, insulin, and insulin syringes sold at EPIC participating pharmacies. Members pay a co-payment each time they purchase drugs; they still save a substantial portion of the price of the drug. Higher income EPIC members can choose to buy drugs at their full price until the total of all their spending for the year reaches a limit (called a deductible); above that limit, they will then save at least half the cost of each prescription for the rest of the year.

Membership fees are on a sliding scale, depending on income and marital status. For more information or applications, call the EPIC help line at 1-800-332-3742, or write to P.O. Box 15018, Albany, NY 12212-5018.

Q. What kind of help do drug manufacturing companies offer?

A. Many manufacturers have patient assistance programs to provide drugs free to low-income patients, or to limit the cost for others. These programs are often tied to specific drugs. People who need particular prescription drugs—especially those that are expensive—and do not qualify to receive them through EPIC or ADAP, should check with the drug’s manufacturer about whether the company has such a program.

To find out more about patient assistance programs, call 1-800-762-4636, or visit www.phrma.org. You will find even more complete information at www.rxassist.org.

Q. If I know my medication is available from the manufacturer through a patient assistance program, how do I go about getting into this program?

A. Different drug manufacturers have different application forms and eligibility requirements. You may have to send a fee in with your application; if so, make sure you know the company’s refund policy before you apply. You can get help with application forms from:

Q. What are the "drug discount cards" offered by some companies?

A. Some drug manufacturers offer discount cards to the elderly and people with disabilities. Most cover only products made by one company; a card that is used by many companies is the Together Rx Care, available by calling 1-800-865-7211. Check www.medicare.gov web site for the approved list of drug discount card providers.

Q. Is it legal to get prescription drugs from Canada, where they are cheaper?

A. Many medications are much cheaper in Canada, and can be ordered on-line from websites like www.canadarx.com, and www.lepharmacy.com. However, buying prescription drugs from an on-line pharmacy in Canada or any other foreign country is considered “personal importation,” which is prohibited by the U.S. Food and Drug Administration (FDA). It might also be considered “personal importation” to fill prescriptions for another person in a foreign country, or to buy large quantities of a prescription for yourself. The FDA has discretion in how rigidly it enforces this prohibition. You should not run into any problems as a result of filling a single prescription while you are traveling in another country.