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Financial & Assistance Programs for Persons with Diabetes
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Assistance programs for free or reduced-cost insulin, prescription medications, and diabetes supplies
Important Disclaimer - Islets of Hope provides this information for general information and it is not
intended to be a recommendation or endorsement of any program or
entity. Please contact the company directly as information may change, programs may be discontinued, or there may be certain changes in restrictions for qualifying for assistance. Program information is subject to change without notice.
Please be sure to contact the administrator of any program before submitting an application.
Hock's offers 30-50% discounted prices on diabetes supplies. We cannot specifically recommend or endorse any company but we have been listing Hock's in our resource directory for over a year as one of the two cheapest online companies to purchase from. We recently affiliated with Hock's because our own experience with them has been so positive. If you do place an order through our site, they will contribute financially towards our cause and you will get reasonable prices for diabetes supplies.
You might also be interested in:
National Patient Assistance Programs for Diabetes Prescriptions and Supplies
Continued
Department of Health and Human Services - To find low-cost
health clinics.
DestinationRX - Use locator to compare drug prices and find cheapest sources.
DHF Medical
Assistance Program partners with pediatric hospitals and pharmaceutical
companies to ensure low-income patients care still able to get healthcare and
medications. (DHF is located in Canada)
Diabetes Trust
Foundation - Phone: 205-939-3402 or
800-577-1383; Fax: 205-939-3408
DuPONT PHARMACEUTICALS
Product Covered: Most marketed non-controlled
prescription products
Chestnut Run Plaza, Hickory Run Bldg. 974 Centre Rd.
Wilmington, DE 19805 Toll Free #: (800)
474-2762
Counties: All Arkansas
Counties
Eligibility: Eligibility is based on the patient's
insurance status and income level/assets. Patients should have exhausted all
third-party insurance, Medicaid, Medicare,
and all other available programs.
The patient must be a resident of the United States.
Other Program
Information:The physician should request an application by calling
1-800-474-2762, prompt 5. The physician must complete and sign the
physician-designated area of the application and include a signed, completed
prescription. The patient must complete and sign the patient-designated area of
the application and include a copy of their most current 1040 tax form. The
application should be mailed to the address above. It takes approximately two
weeks from receipt of an approved application for delivery of medication to the
physician.
EISAI
INC.
Product Covered:
Aricept (donepezil HCI) 5mg & 10mg tablets
Toll Free #: (800)
226-2072
Eligibility: Eisai Inc., and Pfizer Inc., have
developed the Aricept Patient Assistance Program for those U.S. residents
without prescription drug coverage through either public or private insurance.
Aricept will be provided free of charge to patients who meet the following
criteria: Patient has no insurance or other third-party payer prescription drug
coverage, including Medicaid coverage or Medicare managed care coverage.
Patient's annual income must fall within a predetermined range. Patient must be
diagnosed by a physician as having mild to moderate dementia of the Alzheimer's
type.
Other Program Information: Patient must requalify
after 90-day initial supply.
EISAI INC/JANSSEN PHARMACEUTICA, INC.
Product Covered: Aciphex (rabeprazole sodium) 20 mg
tablets
Aciphex Patient Assistance Program
Toll Free #:(800)
523-5870
Eligibility: Eisai Inc., and Janssen Pharmaceutica,
Inc., have developed the Aciphex Patient Assistance Program for those U.S.
residents without prescription drug coverage through either public or private
insurance. Aciphex will be provided free of charge to patients who meet the
following criteria: Patient has no insurance or other third-party payer
prescription drug coverage, including Medicaid coverage or Medicare managed care
coverage. Patient's annual income must fall within a predetermined range.
Program specialists determine eligibility for each patient. The program requests
that physicians not charge patients beyond insurance coverage for professional
services. Patient must be diagnosed by a physician as having a medical need for
Aciphex.
ELAN
PHARMACEUTICALS, INC.
Product Covered:
Permax, Janaflex, Diastat, Mysoline, Zonegran Prescription Assist. Program-c/o
Athena Rx Home Pharmacy
800 Gateway Boulevard South San CA 94080 Toll Free #:
(800)528-4362
Eligibility: The patient must be a resident of the
United States, have a net worth less than $30,000 and no third-party
prescription drug coverage.
Other Program Information:The
prescribing physician and patient must provide the following to Athena Rx Home
Pharmacy: a letter of denial from the state Medicaid program; the patient's most
recent income tax return, three consecutive bank statements of financial
statements from the same account; a letter on the physician's letterhead
requesting the medication and assurance on financial need; and a prescription
for a one-year supply. Once the request is approved, the product will be shipped
quarterly to the patient via UPS delivery. New requests must be filed for
additional product.
Eli Lilly and Company - Lilly Corporate Center, Indianapolis, IN 46285 - Humulin (insulin), Humalog (insulin), Glucagon (emergency kit)
Eli Lilly “Lilly Answers;” A Prescription Assistance Program
– A program for qualified senior citizens that offers drugs made by Eli Lilly
at substantially reduced costs. Lilly
makes insulin and Dymelor (a sulfonylurea).
Persons must have a medical disability (diabetes), no other prescription
drug coverage, be enrolled in Medicare, and meet income requirements. See site for full details. Phone: 1-800-795-4559
Lilly Cares Program - A program for diabetics that cannot afford their insulin. Lilly offers free, 3-month supply of insulin, the possibility of renewal. Eligibility determined by consultation with your doctor who needs to call Lilly Cares at 1-800-545-6962. May cover Humulog and Humilin insulin and
glucagon.
Lilly Cares
PO Box 230999
Centerville, VA 20120
1-(800) 545-6962 (phone)
Lilly Cares is a patient assistance program provided by Lilly. As
part of the company's efforts to provide access to our products for legal U.S.
residents regardless of their ability to pay, we created a program to offer free
medication, through physicians, to patients who are otherwise unable to obtain
our products. Lilly Cares assists patients who are uninsured and whose income is
less than 200 percent of the federal poverty level. Most Lilly products are
available through the program.
Eligibility is based on the patient's
inability to pay and lack of third-party drug payment assistance, including
insurance, Medicaid and government, community, or private programs and cannot be
eligible for Medicare. Applications are available to anyone and must be
completed and signed by the patient and the physician. Patients can download a
blank application from the Lilly Cares website or applications can be faxed to
you by calling 1-800-545-6962.
Lilly Canada Cares - Lilly Canada Cares Insulin Assistance Program (Note: Individual must apply to this program through a Health professional only - such as a Diabetes Educator). Phone: 1 (888) 479 7587 ext. 3006 (Information line for Health Care Professionals). This program will provide insulin to patients who cannot afford it and do not have government or private insurance (approximately 3 month supply). Those eligible for this assistance include patients requiring insulin whose household incomes fall below Statistics Canada Low-Income Cut-Off levels AND who do not have other government or private health insurance. The supply will be delivered to the designated Diabetes Education Centre for the individual to pick up. If the need is still present after three months the individual, with their Health Care Professional can reapply.
ELI
LILLY AND COMPANY
Product Covered:
Most Lilly prescription products and insulin
Lilly Cares Program
Administrator P.O. Box 23099
Centreville VA 20120 Toll Free #: (800)
545-6962
Eligibility: Patients must be U.S. residents.
Eligibility is determined on a case-by-case basis in consultation with each
prescribing physician. Eligibility is based on the patient's inability to pay
and lack of third-party drug payment assistance, including insurance, Medicaid,
government-subsidized clinics, and other government, community, or private
programs. Inpatients and those who can obtain drug reimbursement from any source
are not eligible. Requests for replacement drugs cannot be honored. Medications
are provided directly to the physician for dispensing to the patient. Quantity
of supply is dependent upon type of product being prescribed. All Lilly
medications must be used as recommended in product labeling.
Other
Program Information:Forms to qualify a patient for the program will be
provided to the physician. On this form, the physician is requested to provide
prescription information, including signature and DEA number, and to confirm the
patient's ineligibility for other forms of outpatient drug coverage.
Additionally, the patient is requested to provide pertinent information and
state financial need. Subsequent request for same patient requires another
prescription and restatement of medical and financial need. Program guidelines
may be subject to change.
Everyone’s
RX – This site’s program offers access to reduced cost American brand name
medications to U.S residents that financially qualify. Typically, people making less than
$25,000 per household or $16,000 for a single person can be assisted. The program offers prescription assistance for low income
patients, information on medication research, access to medical care for
pre-existing health conditions, pharmacy aid to community clinics, and pharmacy
discounts to their patient members.
Free Medicine Foundation - Charges $10.00 to apply for each free presciption. "As advocates for patients seeking prescription medicine assistance, Free Medicine Foundation is committed to getting the word
out and helping patients apply for free
medicine. A volunteer organization that puts people in touch with
sponsors willing to supply free medication.
FUJISAWA HEALTHCARE, INC.
Product Covered: Prograf capsules (tacrolimus,
FK506)
c/o Covance Health Economics & Outcomes Services P.O. Box 7710
Washington DC 20044-7710 Toll Free #: (800)
477-6472
Eligibility: Fujsawa Healthcare, Inc. developed the
Prograf Patient Assistance Program to help improve access to oral Prograf for
patients who have no health insurance for Prograf and limited financial
resources. To be eligible for the program, patients must meet income and
insurance criteria set by Fujisawa Healthcare. Please call the Prograf
Reimbursement Hotline (800-4-PROGRAF) for an application or for information
about eligibility. If you describe a patient's insurance and financial
situation, Hotline staff can determine whether the patient is likely to qualify
for the Program Patient Assistance Program.
Other Program
Information:To enroll a patient, physicians must first register with
the program. Registered physicians may enroll patients by submitting a patient
enrollment form and a prescription. If approved, the patient will receive two
90-day shipments of Prograf from a mail-order pharmacy affiliated with the
program. The pharmacy will bill the patient $20 per shipment for expenses
associated with dispensing the shipping the product. If continued assistance is
required after six months, the
physician must reapply for the
patient.
GEMZAR
Product Covered:
Gemzar
Gemzar Patient Assistance Program Toll Free #: (800)
Eligibility:Applications for the program are available by
calling the toll-free Gemzar Hotline. Applicants determined to be eligible based
on program income criteria will be approved on the basis of these additional
criteria; no medical insurance, and ineligible for any programs with a drug
benefit provision, including Medicaid, third-party insurance, Medicare, and all
other programs have denied coverage for Gemzar in writing, and all appeals have
been exhausted.
GENENTECH, INC.
Product Covered:
Pulmozyme (dornase alfa) Genentech Endowment for Cystic Fibrosis
4828 Parkway
Plaza Blvd., Charlotte NC 28217-1969 Toll Free #: (800)
297-5557
Eligibility: The Endowment offers three programs
designed to meet the special needs of the cystic fibrosis (CF) population. If
you are uninsured, the Endowment offers an Uninsured Patient Program. You may
also be eligible for this program if you have insurance but the policy has
certain coverage limitations, such as no drug benefit. If you have insurance,
you may qualify for assistance through the Co-payment Assistance Program. This
program assists qualifying patients with Pulmozyme out-of-pocket co-payment
requirements based upon a sliding scale adjusted for income, family size, and
other pre-established criteria. Both uninsured and underinsured patients may
benefit from the premium Assistance Program. This program assists qualifying
patients with insurance premium costs. Assistance levels are based upon a
sliding scale.
Other Program Information: Patients may be
enrolled in only one program at a time. In addition to the programs described
above, the Endowment assists qualifying patients with the purchase of nebulizers
and compressors for Pulmozyme and administration.
GENENTECH, INC.
Product Covered:
Activase
(Alteplase), Herceptin (Trastuzumab), Nutropin, Genentech Assistance Program
Nutropin AQ, Protropin, Rituxan & TNKase
P.O. Box 2586,
South San CA 94083-2586 Toll Free #: (800)
879-4747
Eligibility: For consideration of eligibility for
the Genentech Assistance Program, the patient must not be eligible for public or
private insurance reimbursement and must meet income
restrictions.
Other Program Information:For reimbursement
assistance for Nutropin, Nutropin AQ, or Protropin, the physician must contact
the Single Point of Contact (SPCO) Reimbursement Department at (800) 545-0488.
For reimbursement assistance for Activase or TNKase, an application must be
completed by the treating hospital. For furtherinformation and assistance the
physician may contact the Genetch Reimbursement Hotline at (800) 530-3083. For
reimbursement assistance for Herceptin or Rituxan, an application must be
completed and signed by the treating physician.
GENETICS INSTITUTE, INC.
Product
Covered:
Benefix Coagulation Factor IX (recombinant)
The BENEFIX Reimbursement &
Information Program
1101 King Street, Suite 600, Alexandria VA 22314
Telephone #: (888) 999-2349
Eligibility: The program is designed to provide
temporary assistance to patients who meet the predetermined eligibility
criteria. Eligible patients must be without prescription drug coverage from a
third-party payer. Patients who meet the eligibility criteria are eligible for a
period of 90 days, at which time they must requalify for the
program.
Other Program Information:Application forms are
sent to physicians who are treating specific patients who may qualify for the
program. Application forms must be signed by the patient
and physician prior
to returning to the program.
GENZYME CORPORATION
Product Covered: Ceredase (alglucerase
injection) Cerezyme (imiglucerase for)
c/o Wytske Kingma, M.D.-Medical
Affairs injection)
One Kendall Square Cambridge MA 01239-1562 Toll Free #:
(800) 745-4447, ext 17808
Counties: All Arkansas
Counties
Eligibility: Based on financial and medical need.
Must be uninsured and lack the financial means to purchase the drug. In order to
maintain eligibility, patients and their families are expected to continue
exploring alternative funding options with the Genzyme Case Management
specialist. These options include private insurance, government programs and/or
charitable sources.
Other Program Information:The CAP
Program is considered a temporary funding program.
GILEAD SCIENCES, INC.
Product Covered:
DAUNOXOME, VISTIDE
Reimbursement Support & Assistance Program Toll Free
#: 800-226-2056
Eligibility: Gilead Sciences Reimbursement
Support and Assistance Program is designed to assist both insured and uninsured
patients in receiving reimbursement for VISTIDE or DAUOXOME. To determine
eligibility for this program, physicians or patients may request a Patient
Assistance Program application for VISTIDE or DAUOXOME, and mail or fax the
completed form to Gilead Sciences Reimbursement Support and Assistance
Program.
Other Program Information:The program offers
insurance claims assistance, referrals for financial support, referrals to AIDS
service agencies. Support specialists consult with insured patients and their
physicians regarding prior authorization or third-party insurance claims,
contact insurance companies on behalf of patients and contact patients and
physicians to offer appeal procedures.
GlaxoSmithKline - Makers of Avandia (rosiglitazone) and Avandimet (combo of Metformin and Avandia). Two programs offered: GlaxoWellcome Patient Assistance Program and the SmithKline Foundation Access to Care - 1-800-546-0420; 1-800-729-4544
GLAXOSMITHKLINE
Product Covered: All
marketed Glaxo Wellcome prescription products Glaxo Wellcome Inc.
Patient
Assistance Program
P.O. Box 52185 Phoenix AZ 85072-2185 Toll
Free #: (800) 722-9294
Counties: All Arkansas
Counties
Eligibility: The Glaxo Wellcome Patient Assistance
Program has been established to provide short-term assistance to eligible
patients until alternative funding can be found. All Glaxo Wellcome medications
used in an outpatient setting are available. The Glaxo Wellcome Patient
Assistance Program is a philanthropic activity of Glaxo Wellcome. The Program is
intended to serve patients who do not have drug benefits through private
insurance or government-funded programs. The Patient Assistance Program is not
intended to replace government programs.
Other Program
Information: The Glaxo Wellcome Patient Assistance Program not only
provides medications but also provides reimbursement services to help patients
locate other payment sources that may provide more comprehensive health care
coverage. Health care advocates should fill out the application form and call
1-800-722-9294 to enroll patients. Completed applications are reviewed against
the company's established criteria on a case-by-case basis. Income eligibility
is based upon multiples of the federal poverty level adjusted for household
size. The only fee that patients are required to pay to participate in the
program is a nominal pharmacy co-payment. Program benefits for outpatient
products are provided through pharmacies. Injectable products are provided to
the health care provider via direct product shipment.
GLAXOSMITHKLINE
Product Covered:
Amoxil, Augmentin, Avandia, Bactroban, Compazine, Coreg, SmithKline Beecham
Foundation Access to Care Dyazide, Famvir, Paxil, Relafin, Requip & Tagamet
c/o Express Scripts/SDS
P.O. Maryland MO 63043-8564 Toll Free #: (800)
546-0420
Eligibility:The patient has a medical condition for
which the medication is needed. The patient has represented that his/her annual
household income is under $25,000. The cost of the patient's prescription is not
fully covered by medical insurance, government aid (e.g. Medicare) or private
programs, and in the opinion of the treating physician, the cost of this therapy
may impose significant hardship on the patient or result in noncompliance with
treatment.
Other Program Information: Application forms can
be obtained by calling 1-800-546-0420. The patient and the physician fill out
the application and should be sure to include all information. Incomplete forms
will be returned. Both patient and physician must sign the form. The physician
indicates the strength and dosage of the requested product on the prescription.
A separate form and prescription must be sent for each individual. All requests
must be submitted on an original SB
Foundation Access to Care form.
Photocopies of the application will not be accepted under any circumstances.
Reapplications are required. The product will be sent to the patient's home and
will require a signature upon delivery. Third-party requests will not be
honored.
GlaxoSmithKline - Bridge to Access is a patient assistance program for non-oncology medicines,
provides GSK prescription medicines to eligible low-income patients without
prescription drug benefits. To apply via phone, call 1-866-PATIENT to receive by
fax or mail.
Bridges to Access
PO Box 29038
, Phoenix, AZ 85038-9038
Phone: 1-866-PATIENT(728-4368)
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