Finding Financial Assistance for Treatment
Many illnesses, such as spinal muscular atrophy, come with steep price tags. Once you have a diagnosis, navigating treatment expenses can be challenging.
Insurance plans cover some expenses. But out-of-pocket costs add up quickly. We regularly get questions about how to access financial assistance. We have gathered some general information and resources.
What is treatment assistance?
Treatment assistance programs help you afford prescription or medical co-pays. The co-pays are for the treatment of a particular illness. Both drug companies and other organizations may offer assistance. You can ask for resource recommendations from:1,2
- Your doctor
- A patient advocate
- A social worker
Drug company assistance
Drug companies often offer assistance for their particular drug. They choose to provide these programs. The government does not require companies to offer programs. Each company sets its own guidance for who is eligible. Often these include:2
- Having no insurance or having insurance that does not cover the drug
- Making less than a certain level of income
- Being a US citizen or legal resident
Companies that offer assistance include a form on their website. They may want to see a doctor's certification of your diagnosis. They may also want a copy of your prescription.
RxAssist has a searchable database of drugs and drug companies offering assistance.2
Patient Advocate Foundation Co-Pay Relief
This foundation assists with co-pays, insurance deductibles, or coinsurance payments. The funds are not limited to prescription drugs, but some restrictions exist. You must meet certain eligibility factors for consideration. These include:3
- You must be diagnosed with one of the 100+ diseases the program covers.
- You must have an insurance plan that includes prescription drug coverage.
- You must fall within predefined low-income brackets.
Funds are available on a first-come, first-served basis. The money awarded is meant to last you for 12 months. You must reapply each year. If you use up your award in less than 12 months, you will not get additional funds. And you cannot reapply before the end of 12 months. You can only apply for assistance with 1 disease for 12 months.3
The Assistance Fund
This organization provides financial assistance for co-pays, deductibles, coinsurance, and other medical expenses. There are nearly 80 eligible diseases covered in this program. Eligibility criteria include:4
- Status as a US citizen or permanent resident
- Household-based financial income
- An official diagnosis of the disease under application
- Treatment approved by the US Food and Drug Administration
- Prescription coverage for treatment
This program operates on a waitlist policy. Upon approval, you are placed on the waitlist in the order you applied. Awards are on a first-come, first-served basis. The availability of funds can change throughout the year. Apply at the start of the calendar year for the best chance of getting funds.5
Each waitlist expires at the end of the calendar year. For consideration in the next year, you must reapply. Having a placement on the waitlist does not guarantee funding. You may apply for assistance with multiple diseases. But you must meet the eligibility requirements for each disease.5
Medicaid and CHIP (Children’s Health Insurance Program) provide health insurance to people who have a low income. Factors that go into whether you are eligible for these programs include:6
- Being a US citizen, US national, or person with appropriate immigration status
- Size of your household
- Disability status
Program funding is through federal and state governments. Program administration is by each state. Rules and eligibility vary between states.6
Have you found something to help you mentally cope with SMA?