First started in 2002, Hawaii’s drug assistance program, called Rx Plus, is designed to help low- to middle-income Hawaii residents get help with their prescription medication costs. Rather that using the Patient Assistance Programs, the state actually negotiates lower drug acquisition costs and passes those savings on to consumers.

The program is called Hawaii Rx Plus. It is a free discount program for residents who earn too much money to qualify for Medicaid and either do not have insurance or have prescription drug needs not fully covered by their insurance.

The problem with the program is that the government is not actively pursuing the deals as set forth in the legislation.  The wording actually stated that they “may” negotiate, which left it open to avoiding the talks all together. The result has been that rates haven’t been as low as they could be.

State House and Senate Democrats, over Gov. Linda Lingle’s veto, amended the law this year to require the administration to negotiate by simply changing the word “may” to “shall.” The new law also requires the state to tell doctors about the differences in drug costs between manufacturers that offer rebates to the state and those that do not.

They are in a place now where they are ready to go to bat for their patients, but with an enrollment of just 112,000 people (all of whom make less than 3.5 times the poverty level), they need to start enrolling new patients rapidly to have the buying power that they need to get even better deals.

“The success of the program depends on the number of people we can enroll quickly,” Lillian Koller, director of the state Department of Human Services, said at the time. “As enrollment grows, we will be able to leverage our purchasing power with drug manufacturers and achieve greater discounts for our participants.”

Unfortunately, Hawaiians have not gotten the level of benefit that was expected from this program when it was created. They have faced opposition from lawmakers and manufacturers, and advocates have been left feeling frustrated on many levels. Hawaii should be proud of their efforts to provide prescription assistance to those in need, and we can only hope that they are able to soon provide the support that they had planned for.

Brand name drugs received through PAPs are FREE. However, if you need generic drugs, there will be a fee for your medications.

Generic drugs are NOT offered through Patient Assistance Programs, but rather by two companies that offer generic medications at a low cost for low-income patients.

The two companies that offer low-cost generic medications are:

• http://www.rxoutreach.com/
• http://www.xubex.com/

RxOutreach offers generic medications for $20, $30, or $40 for a 3 month supply, depending upon the medication. There are income requirements to use their program, and they can be found here. The amount varies depending upon how many people live in your household. To receive low-cost generic medications, you just need to:

• Print the form.
• Fill it out according to their directions and go to your doctor to get a 90 prescription for EACH medication you are applying for.
• Return it to them with your prescriptions and payment.

You can see their available medications here.

Xubex.com is another company that offers low cost generic medications. Their income requirements are here. You must also:

• Be a United States resident
• Must provide a recent proof of income
• Must provide a valid prescription indication number of refills
• Patients enrolled in Medicare Part D are eligible

You can see their complete medication list here. You only need one application for all of your medications, but you DO need an accurate prescription for each medication. The costs for their generic medications are:

• $20.00 – 90 day supply
• $40.00 – 180 day supply
• $80.00 – 360 day supply

These two companies were created to address the problem that you cannot get free generic medications through Patient Assistance Programs. These companies buy generic medications in bulk from the manufacturers and pass it on for a small administrative fee (to cover the cost of processing paperwork, storing the medications, shipping, etc.).

This is a great service for those who need it and who qualify, so don’t hesitate to take advantage of these low-cost generic medications!

Once you have gone through the entire process of researching the Patient Assistance Programs that offer your medications, filling out the forms, providing the proof of income, and mailing in any other necessary documents, it can be incredibly frustrating to the be denied your free medication.

Denial could come for many reasons:

• You may have forgotten to fill out a section of the application.
• You may have forgotten to include your proof of income.
• You may have forgotten to include your prescription.
• You may have forgotten to have your doctor sign the form.
• You may have been over the income limits.
• Plus a number of other possible factors.

If you get a dreaded denial letter, make sure that you don’t get frustrated before you take a look at your appeal options.

If you are slightly over the income limits of the PAP, it’s possible that they will accept an appeal letter for your physician that describes the level of medical necessity and the hardship that doing without the medication would cause. You need to prove to them that it would be a financial hardship to purchase the medication in order to have your appeal considered. There is NO guarantee that you will get assistance from the PAP - there is just an appeal process for you to let the PAP know why you should be eligible, and they make that determination on a case by case basis.

In a case where you have prescription coverage, but you have totally maxed out your benefits, you may still be eligible for coverage if you send in a letter stating your situation. If you can provide official documentation regarding your maxed out state with your insurance company, that will aid your cause. Again, there is no guarantee that you will get help - each PAP decides appeals on a case by case basis.

In the event that you made errors or omissions on your application, you can simply reapply with the correct information filled out.

The process for applying for free medication CAN be frustrating and complicated, but the insurance companies have policies in place for very good reasons. The decisions are made by them on a case by case basis and they truly want to help those in need, so do what you can to show them how dire your situation is.

Patient Assistance Programs were created, for the most part, for people who lack health insurance or prescription coverage.

However, just because you do have certain coverage doesn’t mean that you will certainly be denied. Because each program sets their own guidelines, it’s possible that there is help for you if you are struggling to pay for your medications. For example, some people have annual or quarterly caps on their prescription coverage, so there are PAPs that will kick in once that ceiling has been reached. The most important thing to do is to locate the free medicine that you need and read the requirements.  If you have any questions, you can call the company directly.

Here are some possible scenarios that might be eligible for help:

• No health or prescription coverage.
• Yes health insurance, but no prescription coverage.
• Prescription coverage, but limits have been reached.
• Cannot qualify for state aid like Medicaid.
• The medication is a hardship to purchase for the patient.

Each of these cases is unique and no matter how simple that your situation may be, all decisions to offer assistance are up to the individual drug company.  There are no guarantees that assistance will come, though they do try to provide for a wide number of real-life scenarios.

If you are denied, you can follow an appeals process to try and get coverage approved under special circumstance.

The application process to receive free medication through Patient Assistance Programs provided by pharmaceutical companies involves providing information about yourself on the provided patient application form for the medication you need. If you need more than one medication from more than one company, you will need to fill out more than one form. Make sure that you use the appropriate, most up to date forms when applying!

In general, you need to be ready to supply this information about yourself, or the patient that you are helping:

• Age
• State and Zip Code
• Annual Income
• Number if people living in their home
• Names of medications needed
• Current state of health coverage

Once you have the forms printed out, make sure to add all of the information that you can. There are going to be places where you need to sign and places where your doctor needs to sign. Just in case your doctor is not familiar with Patient Assistance Programs (he could be hesitant to take the time to do his part), have ALL spaces filled with the proper information. Your doctor or health care provider will have to attach or enter the prescription information and sign the forms. You can then send the information to the PAP yourself with your supporting documents.

Once you have sent in all the necessary information, you are ready to wait for their response. Good luck!

In order to understand how it’s possible to receive free and low cost medication from the pharmaceutical companies, the first step is understanding exactly what a Patient Assistance Program (PAP) is and how it can help you.

PAPs are programs run independently by pharmaceutical companies. They offer free and low cost prescription medications - the same medications found in pharmacies around the country - to low income, indigent, and uninsured people. These programs provide much-needed support for those who cannot afford their medication costs, but most people are still not aware that these programs exist.

Each company runs its program differently with different deadlines, qualification criteria and procedures. While just about all use income as one of their qualifying factors, they all have different levels of eligibility. So if you do not qualify for one program because you make too much money, it’s possible that you can apply for another program with a similar medication (as directed by your doctor) that has higher income limits. Check with your individual free drug program to find out if you might qualify.

These programs are designed to help, yet so many of those who need the assistance aren’t aware that help is out there.

Do you have any specific questions or comments about Patient Assistance Programs? Do you have a story to share about your journey to free medicine? Please share it with us!