American Cancer Society
- Information on which local chapters of the ACS or other organizations offer financial assistance to patients with cancer that meet certain financial criteria
- Call with patient's zip code and county
American Kidney Foundation
- For patients with chronic kidney disease only (on dialysis or transplanted)
- The maximum grant is $200
- There is a financial statement to complete and signatures of physician and social worker are required
- May be most appropriate for patients that are from out-of-state as WI has the Wisconsin Renal Disease Program
- Turn around time is 4-8 weeks
Badger Rx Gold
- (866) 809-9382
- BadgerRx Gold is not a drug discount card. It is a program that offers lower costs on carefully selected medications monitored for your safety and well-being through a team of Wisconsin physicians and pharmacists
Charging Meds to a Patient’s Account
Effective 10-1-2010, charging will only be approved for short bridge supplies (3-4 days for local patients and 5-7 days for out of area patients) to accommodate immediate medical need
These meds are not free, they are billed to the patient
Contact the Pharmacy Fiscal line at (608) 890-6431
Evenings, Weekends and Holidays
Contact the Outpatient Pharmacist at (608) 263-1280
- If patients meet certain financial criteria they may be eligible for this program
- If patients qualify, their care, possibly including their meds, will be provided without charge.
- Refer patients to 2-2221 or (866) 841-8535
- According to a new Surgeon General-led task force, smart shoppers can snag discounts as high as 75% with some old-fashioned bargain hunting.
Co-pay and Insurance Payment Assistance for Patients
- Healthwell Foundation
- An independent, charitable organization that assists financially need individuals in obtaining prescription medications. Also provides financial assistance to eligible individuals to pay insurance premiums or co-payments.
- (800) 675-8416
- Patient Access Network
- A non-profit 501(c)(3) organization dedicated to supporting the needs of patients that cannot access the treatments they need due to out-of-pocket health care costs.
- (866) 316-7263
- Patient Services Inc
- A non-profit organization primarily dedicated to providing health insurance premium assistance, pharmacy co-payment assistance and co-payment waiver assistance for persons with specific expensive chrinic illnesses.
- (800) 366-7741
Dane County Mental Health Center
(608) 280-2700 main
(608) 280-2510 for medication program
- Provides psychiatric medications to their patients that meet certain criteria:
- Must be stable on medications for 6+ months
- Must be a Dane County Resident
- Must meet certain financial criteria (have sliding scale co-pays)
Fund Raising and Grants for Transplant Patients
- National Foundation for Transplants: (800) 489-3863
- Fund-raising campaigns for transplant candidates and recipients needing $10,000 or more for their transplant-related care and/or medications
- Grants for patients, with smaller, non-recurring needs for medications and other transplant-related emergencies.
- National Transplant Assistance Fund: (800) 642-8399
- National Transplant Assistance Fund (NTAF) is a not-for-profit resource serving all organ and tissue transplant patients, their families and the professional community who treats them. NTAF also provides services for patients with catastrophic injury. Provides fund-raising expertise for patients raising money for uninsured medically related expenses, $1,000 challenge grants for eligible patients and educational information regarding organ/tissue donation.
General Relief/Interim Assistance
- Some counties offer General Relief/Interim Assistance Programs that may cover the cost of medications
Glaxo Smith Kline
- GlaxoSmithKline Bridges to Access: (866) PATIENT or (866) 728-4368
- Patient assistance program for non-oncology medicines, provides GSK prescription medicines to eligible low-income patients without prescription drug benefits
- GSK Access
- Provides GlaxoSmithKline prescription medications at no cost to Medicare Part D Prescription Drug Plan enrollees who meet the eligibility requirements
- GSK Commitment to Access
- Patient assistance program for oncology products. Eligible patients may receive GSK oncology products at no cost
- Good Days from CDF provides financial support for patients who cannot afford the medication they urgently need. With our proprietary enrollment system, we have streamlined the application process so patients can be conditionally approved in just minutes.
- (877) 968-7233
- Will voucher the cost of meds to Walmart in Monroe while we are awaiting MA/SSI
- Has workers that will help elderly clients with indigent drug program applications
- The Wisconsin Health Insurance Risk Sharing Plan (HIRSP) offers health insurance to Wisconsin residents, who, due to their medical conditions, are unable to find adequate health insurance coverage in the private market
- Patients are responsible for 20% co-pay, up to $25 OOP
- For patients with Medicare
- In Plan 1 (not enrolled in all 3 parts of Medicare), HIRSP covers drugs on the HIRSP formulary with above co-pay
- In Plan 2 (enrolled in Medicare D), HIRSP covers drugs on the Medicare D formulary as a secondary payor
- For more information, direct patients to (608) 221-4551
(217) 782-6333 or (800) 962-8384
- The Illinois Comprehensive Health Insurance Plan (CHIP) is a program that is established and maintained by the State of Illinois to provide health insurance coverage for residents of Illinois who, due to the existence or history of a medical condition, are unable to acquire coverage through private insurance, an HMO or an employer sponsored group health plan
- Deductibles range from $500 – $2,500 (deductible does not need to be satisfied in order to use the prescription drug program)
- 20% coinsurance (this includes drug benefit)
- There is a limit of 45 days per calendar year on hospital services provided by any hospital located more than 75 miles outside the State of IL
- Explanation of Plans:
- Plan 2 (Section 7): available to persons enrolled in Medicare A and B due to disability or ESRD, and meet Section 7 criteria (see brochure). 6 month pre-existing condition limitation.
- Plan 3 (Section 7): PPO for persons not eligible for Medicare and meet Section 7 criteria (see brochure). 6 month pre-existing condition limitation.
- Plan 5 (Section 15): PPO for persons who qualify for HIPAA-CHIP under Section 15 and are not eligible for Medicare. No preexisting condition limitation.
- A program that offers residents of Illinois, Kansas, Missouri, Wisconsin, and Vermont access to prescription drugs from licensed and inspected organizations in Canada, Ireland, and the United Kingdom
- People who enroll in the program may save from 25-50% on brand name prescriptions
- Covered drugs for chronic illnesses and oral contraceptives are included
- There are no enrollment fees, income or age restrictions
Indigent Medication Programs
- Many pharmaceutical companies have indigent medication programs in which if patients meet certain financial criteria, they may be approved to receive a supply (usually 3 months, which may be renewed) of medications at no or low cost
- Consult UWHC’s Transitional Care Pharmacy Specialist Team, (608) 262-6443
- Consult UWMF's Patient Resources Department, (608) 821-4819
- Consult the internet site Needy Meds.com for a list of participating companies and the medications they provide as well as an explanation of the application process.
- Note this process can take 4-8 weeks to complete.
- Some companies will allow patients with Medicare to apply, some will not. See Rx Assist for an up-to-date list.
Kidney Transplant Immunosupressive Fund
Patient Access Network Foundation uses the following criteria to determine eligibility for assistance
You have to be insured and your insurance has to cover the medication for which you are seeking assistance.
The medication you take must fight the disease directly.
You have to be a US resident.
Your income must fall below 200% of the Federal Poverty Level.
Leukemia and Lymphoma Society
- Leukemia and Lymphoma Society provides some funds for medication reimbursement not covered by insurance.
(877) RX-LILLY or (877) 795-4559
- The LillyMedicareAnswers program provides assistance to eligible patients prescribed Forteo, Zyprexa or Humatrope
- Some of the key eligibility criteria for the program are:
- Enrollment in a Medicare Part D plan
- Not eligible for both Medicare and Medicaid (non-dual eligible people)
- Income at or below 200 percent of the Federal Poverty Level (FPL)
- Proof of low-income subsidy denial
- Signed certification that the patient will not claim or submit any cost incurred or associated with the medications provided under the LillyMedicareAnswers program towards their true-out-of-pocket-cost (“TROOP”) calculation or submit any claim for reimbursement for the medications
Madison Community Health Center
S. Madison Clinic: (608) 261-9270
- Their Medical Assistants will assist patients with applying for the indigent drug programs
Mail Order Pharmacy Programs for Transplant Patients
- The following mail-order pharmacy companies specialize in medications for transplant patients. They are experts at billing Medicare and private insurance companies and most are able to ship a supply of medications on very short notice.
- This is an excellent option for patients with out of state Medical Assistance who are not returning to their home state immediately upon discharge from the hospital. It is also a good option for patients who do not have the cash up front to pay for their first month's supply of medications.
- Medical Assistance is a program available to persons under age 21, pregnant, blind, disabled, over age 65, or a caretaker relative for a dependent child under age 18; who meet certain financial criteria
- Patients that are eligible for both Medical Assistance and Medicare will be enrolled in Medicare D
- Badger Care + extended Medicaid coverage to uninsured children and lower income parents
- Badger Care CORE extended Medicaid coverage to long-term uninsured adults that do not have dependent children
- Katie Beckett allows certain children with long-term disabilities or complex medical needs living at home with their families to access Wisconsin Medicaid coverage.
- If a patient qualifies for MA retroactively, and had paid for medications out of pocket during the time that they were eligible, they should have their pharmacy re-submit their bills to EDS. The pharmacy will be reimbursed, who will then in turn reimburse the patient.
- If the bills are more than 365 days old, the pharmacy will also need to submit a "Timely Filing Appeals Request"
Medicare Coverage of Anti-Rejection Medications for Transplant Patients
- Historically, Medicare Part B has covered 80% of the cost of immunosuppressive (anti-rejection) medications but imposed restrictive time limits. This benefit will stay under Part B even after Part D is introduced.
- Patients can get their anti-rejection medications under Part B only if they had their transplant at a Medicare approved facility (which UWHC is) and had Medicare at the time of their transplant
- Patients who did NOT have Medicare at the time of their transplant may be able to get their anti-rejection medications under their Part D coverage (check their formulary)
- This 80% rule is no longer is true for hospital pharmacies, as the drugs are now assigned APC's, and therefore coverage varies per medication.
- Recognized anti-rejection medications are: Azathioprine (Imuran), Cyclosporine (Sandimmune, Neoral, SangCya, Gengraf), Mycophenolate (CellCept), Prednisone, Sirolimus (Rapamune) and Tacrolimus (Prograf).
- As of January 2006, prescription drug coverage is available through private insurance companies to people on Medicare A and/or Medicare B
- Patients may have both Medicare D and SeniorCare. Medicare D would be considered 1st payor, SeniorCare 2nd payor
- Medicare D Comparisons for Transplant Patients
- Extra Help
- If all else fails during the evening or weekend hours, contact the Nursing Supervisor at pager 7576.
Partnership for Prescription Assistance
(888) 4PPA-NOW or (888) 477-2669
The Partnership for Prescription Assistance brings together America's pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that's right for them.
Many will get them free or nearly free.
Patient Advocate Foundation
The PAF Co-Pay Relief Program, one of the self-contained divisions of PAF, provides direct financial assistance to insured patients who meet certain qualifications to help them pay for the prescriptions and/or treatments they need. This assistance helps patients afford the out-of-pocket costs for these items that their insurance companies require.
- If all else fails during business hours, contact Patient Relations (3-8009) to discuss whether funding may be available to assist the patient
- Hours are 8am-4:30pm, Monday-Friday.
- Helpful Answers: Pfizer Helpful Answers is a comprehensive program to help uninsured Americans, regardless of their age or income, get Pfizer medicines for free or at meaningful savings.
- Pfizer Connection to Care will be removing the following medications from their program:
- Calan SR
- Glucotrol XL
- Pfizer Connection to Care will be removing the following medications from their program:
- Applications for these medication submitted before 07/01/2013 WILL be accepted
- If a patient is currently enrolled into Pfizer Connection to Care for one of these medication and their enrollment expires after 07/01/2013, but before 12/31/2013, their enrollment has been extended to 12/31/2013 for all medications through Pfizer Connection to Care.
If a patient is currently enrolled into Pfizer Connection to Care for one of these medication, but their enrollment expires after 12/31/2013, they will continue to receive the medication until their current enrollment ends
Prescription Drug Helpline:
- (866) 456-8211, 8am-4:30pm, Monday-Friday
- Free information line for Medicare beneficiaries and their families
- Explain various prescription drug programs including costs and benefit coverage
- Assess eligibility for various programs
- If a patient is interested in obtaining private health insurance, a list of FAQ's is available from the State of Wisconsin Office of the Commissioner of Insurance
- We are a nonprofit charity that provides critical medicine for people who can’t afford it. We offer more than 500 medications through our mail order pharmacy.
- Note for transplant patients: Imuran, Tacrolimus and Mycophenolate are all available
The Safety Net Foundation
- The Safety Net Foundation is a nonprofit patient assistance program that helps qualifying uninsured patients access Amgen medicines at no cost
- Examples = aranesp, epogen, sensipar, etc
Saint Vincent de Paul
- The new St. Vincent de Paul Charitable Pharmacy is serving those who have chronic or acute health conditions but who lack the means or the coverage to obtain the prescribed medications needed for treatment. We believe that what we have established here is the first stand-alone charitable pharmacy in Wisconsin.
- It is a fully licensed pharmacy operating on a stand-alone basis and providing prescribed medications at no charge to those low-income individuals who qualify for the pharmacy’s services.
- This means that this pharmacy – not a part of any medical clinic, health network or hospital – honors valid prescriptions that clients accepted into the program have received from physicians and other licensed prescribers.
- Eligible patients are Dane Co residents, uninsured, and their income is at or below 200% FPL
Patient is required to show proof of residency and proof of income. If patient is unable to show a statement of income (ie. social security statement, check stubs, taxes) patient will be provide a letter that needs to be completed by a provider or a family member verifying their income
Eligible patients are given an initial 30 day supply. The patient can then return and become certified to enroll in a program to receive the medication at no cost for 6 months.
After 6 months patient can re-enroll in the program if they continue to meet all the guidelines
New patients need to go in person for intake and take their prescriptions with them. Prescriptions can be faxed when pts who have established care with the pharmacy
- No narcotics will be available
Sauk Co Prescription Drug Program
- Through a partnership with the National Association of Counties (NACo), the free Prescription Discount Card program provides area residents with a card that offers an average of 24 percent savings off the retail price of prescription medications
- Extended through 2009
- For seniors 65 or older
- Must be a U.S. Citizen. Permanent Residents not eligible. Can't already be on MA.
- They are not subjected to an assets test.
- Annual enrollment fee of $30
- (800) 657-2038
- Patients may have both Medicare D and SeniorCare. Medicare D would be considered 1st payor, SeniorCare 2nd payor.
- Formulary Search
Senior Rx Care
- (877) 828-7555
- The Coalition of Wisconsin Aging Groups (CWAG) is pleased to present Senior Rx Care (SRC) which is now offering a One Stop Shop program that will provide CWAG members with the lowest Rx drug prices from the United States, Canada and other approved international pharmacies
State of Wisconsin Prescription Drug Resource Center:
- (800) 537-6390 or (608) 266-6949
- This website gives WI citizens the ability to buy certain prescriptions at significantly lower prices directly from Canadian pharmacies
- It also provides information about SeniorCare, the new Medicare drug benefit, and other programs that may be an option for you
- $4 generics available for certain medications
- The TRICARE Senior Pharmacy Program is available to uniformed services beneficiaries age 65 and over.
Medicare Part D help
8/09: generic tacrolimus has received FDA approval. Patients can initiate the reimbursement program (800) 4Prograf, (800) 477-6723. They will figure out who can continue on brand vs whose insurance will leave them with outrageous co-pays. At that time they will alert us so that we can make plans to monitor these patients appropriately. Medicaid patients should get the same pricing but prior authorizations will likely be requried.
- Eligibility for most VA benefits is based upon discharge from active military service under other than dishonorable conditions. Certain VA benefits and medical care require wartime service.
- If patients think they may be eligible for benefits but have not yet applied, they should be directed to the VA Eligibility line at (608) 280-7038
- Outpatient pharmacy services are provided free to veterans with a service-connected disability of 50% or more, veterans receiving medication for treatment of service-connected conditions, and veterans whose income does not exceed the maximum VA pension. Other veterans will be charged $7.00 for each 30 day or less supply of medication.
- In order for pharmacy services to be covered, the prescription must be written by a VA physician on a VA prescription pad
- Low cost generics available
- $9.99/30 day supply
- $11.99/90 day supply
- In April 2000, samples were removed from the UW Health clinics and replaced with vouchers
- Questions should be directed to the Medication Assistance Program at 2-6443
- $12.99 for a 90-day supply of over 300 generics
- $20/year single enrollment, $35/year for families
- $4 generics available for certain medications
Wisconsin Renal Disease Program
- Available to Wisconsin residents with end stage renal disease. Coverage begins on the first day of regular maintenance dialysis or the date of a kidney transplant.
- Benefits other than drug coverage include a portion of inpatient and outpatient care after all other insurances have paid
- To qualify the patient must:
- Have applied for Medicare Part A and Part B
- Meet certain financial criteria
- To apply, patients should contact Lynn Anderson at 3-1503
- The Estate Recovery Program seeks repayment of benefits from the estates of recipients or their spouses after their death. This is the main reason some patients choose not to apply for this program.
- There is a $1 co-pay for medications
- Formulary Search
2015 Medicare D Cost Sharing
Medication Assistance Program