This resource was compiled by ACT1 Advocacy Committee Member, Caroline.
A note from her on this guide:
I worked with these programs as part of an Americorps term of service. For a year, I helped patients at multiple health centers in Brooklyn access the prescriptions they needed. I became very familiar with the different companies and the application process—so here is an “insider” breakdown on diabetes necessities and how to obtain them.
You can contact her at Caroline@act1diabetes.org with any comments, questions or suggested additions!
Patient Assistance Programs for People with Diabetes
When would I look into applying for patient assistance programs?
- are uninsured
- are underinsured and have a low prescription-cap on your insurance
- have just received temporary support from ACT1 Supply Exchange Program, or
- have no prescription drug coverage,
you may be able to receive medications and test strips for free, for an unlimited period of time. Many pharmaceutical companies have patient assistance programs that have fairly simple application processes. However, you may experience long waits or denials, so what follows are some helpful hints from a seasoned PWD and patient advocate!
The basic application process is this:
Locate the application online (you can search www.rxassist.org), or call the company and have them mail it to you. Fill out the application with your basic information. Include proof of income, as companies will only accept patients below a certain income level. Have the doctor sign the application and provide a paper Rx (rx = prescription) if necessary. Send the application to the company, and if you’re approved, the medicine will arrive in anywhere from 2-6 weeks.
- The best portal to look for medications and to find more information is www.rxassist.org. Go to the website, click on “Patient Center,” and then enter the name of the medication. If you have medications for conditions other than diabetes, you can search for them here; you can also find the contact information for the pharmaceutical companies.
- Call companies to double check application standards. Rules are often changing and vary greatly from company to company. It’s better to check than to wait for weeks on an application that is denied.
- When contacting companies, it may be helpful to ask your provider’s office to call on your behalf. Companies may share more information with a provider than with a patient. (Alternatively, you could simply pretend to be calling from your doctor’s office. Memorize the office’s address and phone number, and refer to yourself as “the patient.”)
- Nearly all applications ask for proof of income. Nearly all applications will accept either the first two pages of your 1040 tax form (your federal income tax return), or a letter signed by your doctor on his/her office letterhead stating that you have no income and you urgently need the medication.
- You can receive medications as long as you don’t have insurance. Simply reorder in a timely manner (3 weeks before the medication runs out is best), and complete a full re-application every year.
Unfortunately, there is only one company with a program for strips—Abbott, the manufacturer of Freestyle meters.
Contact info: Call 1-800-222-6885 and information on their program can be found here.
Eligibility criteria for Abbott’s program include:
- Having a social security number
- Having little to no insurance
- Having been denied Medicaid or are awaiting approval.
Abbott doesn’t publish their income guidelines; the only marker that I have is that $2500/month for a 1-person household is too much. Abbott does, however, accept a zero-income letter on the provider’s letterhead as proof of income if the patient isn’t working.
Roche (the maker of Accu-Chek test strips) also has a test strip assistance program, however as of 2009 it is run solely out of a limited number of local health clinics (a few in each state). Make sure you check it out here to find out if there is one nearby you!
There are 3 primary insulin manufacturers, each company has some specific information that will help you on your way towards accessing their patient assistance programs:
- Sanofi-Aventis (Lantus, Apidra): Requires SSN, accepts faxed applications, and usually sends insulin within 3 weeks, and sends reorder forms directly to you, rather than your medical provider.
- Novo Nordisk (Novolog, Novolin, Levemir): Requires SSN, accepts faxed applications, and usually sends insulin within 3 weeks, and sends reorder forms to the provider’s office (not directly to the patient).
- Eli Lilly (Humalog, Humulin) Does not require SSN (simply put “N/A” if you don’t have one, only accepts mailed applications, sends insulin to you approximately 4 weeks after you send your application, and sends reorder forms directly to you, rather than your medical provider.
Please note: *All three companies will likely deny you if you are eligible for Medicaid; include a denial letter if you have been rejected for Medicaid.*
There are tons of pills for diabetes on the market—the best option is to search for yours on www.rxassist.org. However, bear in mind that several generic medications are available for $4/month—regardless of insurance or income—at Target pharmacies. Here’s the list of generics, with brand names listed in brackets:
Glyburide & Glyburide Micro [Micronase, Glynase,]
Metformin & Metformin ER [Glucophage, Glucophage XR]
Talk with your doctor about whether generics are right for you. It may be easier to pay $4 rather than worry about filling out applications, ordering in advance, etc.
If You Are Denied
It’s always a good idea to call the company after 2 weeks and check that your application has been approved. Often, companies will find a mistake in an application and fail to notify the applicant that they aren’t getting their medicine.
Mistakes or incorrect information is usually easy to fix; however, if you are denied based on qualifications, the process is more complicated. Check with the company to find out exactly why you were denied. You may be able to appeal the decision, either through a company’s formal appeal process or by providing supporting documentation from your doctor. Ask your doctor for help—a company may put a lot of stock in what he/she has to say. Don’t give up! You have a right to the supplies you need to keep yourself healthy.