Financial Assistance Options for Commercially Insured Patients: Where to Turn When Coverage Doesn’t Cover the Full Bill

By Nora Hansen, CPhT
Patient Billing Representative and Certified Oncology Pharmacy Technician, Illinois Cancer Specialists

This is the third in a series of Expert Tips articles from Nora Hansen. Check out Nora’s previous articles on crafting an effective appeal and the Low Income Subsidy program for Medicare patients.

Cancer treatment can be very expensive, even with good insurance. Patients and caregivers have several concerns and fears when going through treatment.  Financial stress only adds to the challenge.

Fortunately, there are programs that can help commercially insured patients who still have an out of pocket cost.

If you have a commercial drug plan (NOT Medicare, Medicaid, or TRICARE), and your medication is for a brand name product, chances are that you can reduce your copay substantially through the following.

Copay Cards

Most manufacturers offer copay card programs, and the only criteria are that you have a commercial plan and live in the U.S. To apply, simply go to the manufacturer website and search for “Savings and Support.” Fill out the application and submit. You’ll be sent a copay card that you can present to your pharmacy. The pharmacy will be able to process your copay card just as it does your insurance. These copay cards often pay most, if not all, of your copay, up to a yearly maximum. There are no income limits to apply for copay cards.

Independent Copay Assistance Foundations

These are not-for-profit organizations that disperse funds for copays and, in some cases, insurance premiums as well. The funds are specific for disease state, and to qualify you must have a verifiable covered diagnosis along with meeting income requirements: usually equal or less than 500% of the Federal Poverty Level (FPL), though requirements vary by fund.

These foundations do great work and are incredibly generous. Some of the larger foundations are:

Manufacturer Patient Assistance Foundations

These are funded by the manufacturer and will provide free drugs for patients who are un-insured or under-insured.  You may be under-insured if you’ve exceeded the maximum benefit limit on your copay card or if there is no copay card available. Manufacturer programs also have an income limit to qualify; usually around 600% of poverty level but again, some vary.

For patients and caregivers, it’s important to ask your physician’s office for help!  For patient-facing reimbursement and navigation staff, knowing about these programs helps you better support your patients by reducing the financial stress associated with their treatment.

What tips and best practices have you found successful for helping commercially insured patients afford their therapy?  Email them to so we can share with the community.

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