Prescription Assistance Programs: How Drug Makers Help You Pay for Medications

When your prescription costs $500 a month and your insurance only covers $50, you’re left with a choice: skip doses, split pills, or go without. For millions of Americans, this isn’t hypothetical-it’s daily reality. That’s where prescription assistance programs come in. These aren’t charity drives or nonprofit initiatives. They’re direct support systems run by pharmaceutical companies like Pfizer, Merck, and Eli Lilly to help patients afford the drugs they need. And they’re bigger than most people realize.

Two Types of Help: Copay Cards vs. Patient Assistance Programs

There are two main ways drug makers help patients pay for meds: copay assistance programs and Patient Assistance Programs (PAPs). They sound similar, but they’re built for completely different people.

Copay assistance programs are for people who have insurance but still can’t afford their out-of-pocket costs. Think of them as coupons you use at the pharmacy. When you present a copay card, the drug company pays the difference between what your insurance covers and what the drug actually costs. For a specialty drug like Humira or Dupixent, that could mean saving $200-$500 per month. These cards are easy to get-usually just a quick online form-and they’re accepted at most pharmacies. But there’s a catch: many health plans now use copay accumulators, which means the manufacturer’s payment doesn’t count toward your deductible or out-of-pocket maximum. So you might pay less each month, but it takes longer to reach catastrophic coverage.

Patient Assistance Programs (PAPs) are for people without insurance or with very limited coverage. These programs give you the medication for free-or for a tiny fee like $10-$15 per prescription-if you meet income guidelines. Most PAPs require your household income to be under 400% of the Federal Poverty Level. For a family of four in 2025, that’s about $60,000 a year. You’ll need to provide proof of income, a doctor’s letter confirming medical need, and proof of U.S. residency. The application can take 45-60 minutes. Once approved, you might get a 90-day supply mailed directly to your home.

Who Gets Help-and Who Doesn’t

Not everyone qualifies. And the rules change depending on what kind of insurance you have-or don’t have.

If you’re on Medicare Part D, copay cards can help reduce your monthly cost. But here’s the problem: that help doesn’t count toward your True Out-of-Pocket (TrOOP) costs. That means you stay stuck in the coverage gap longer. PAPs can’t be used at all if you’re on Medicare Part D or Medicaid in most cases. The government doesn’t allow it-because it could inflate drug prices and create loopholes.

Even worse, 78% of state Medicaid programs ban copay assistance entirely. They see it as a trick that pushes patients toward expensive brand-name drugs instead of cheaper generics. In states like California and New York, manufacturers are now required to report how much they spend on these programs. Some states even limit how much a card can cover per year.

And if you’re uninsured? You might qualify for a PAP-but only if you don’t have any other drug coverage. That includes VA benefits, TRICARE, or even a spouse’s plan. Many PAPs require you to swear you have no other prescription coverage. That’s a problem for people who have partial coverage or are caught in the gaps between jobs.

How Much Help Is Actually Out There?

The numbers are staggering. In 2022 alone, pharmaceutical companies gave $24.5 billion in direct assistance to patients. That’s enough to cover nearly 12.7 million people. And it’s growing. By 2027, that number could hit $38 billion.

Eighty-five percent of specialty drugs now come with some kind of manufacturer copay card. That includes treatments for cancer, rheumatoid arthritis, multiple sclerosis, and severe asthma. For example, Teva’s Cares program gives certain generic medications at no cost. The Asthma and Allergy Foundation of America reports that eligible patients can pay as little as $15 per prescription for Dulera, with savings up to $90 per fill.

But here’s the hidden cost: these programs may be making drug prices worse. A 2022 study in JAMA Internal Medicine found that copay assistance encourages patients to choose brand-name drugs even when generics are available. That pushed total drug spending up by $1.4 billion in one year. Critics argue these programs don’t fix the broken pricing system-they just make it more comfortable for patients to keep paying inflated prices.

How to Find and Apply for Help

You don’t have to figure this out alone. The Medicine Assistance Tool (MAT), run by PhRMA, lets you search over 900 programs by drug name, income, and insurance status. It’s free, confidential, and works on mobile.

For copay cards:

1. Go to the drug manufacturer’s website (search for “[Drug Name] + patient assistance”)
2. Fill out a quick form-usually just name, insurance, and doctor info
3. Print or download the card
4. Present it at the pharmacy when you pick up your prescription

For PAPs:

1. Use MAT to find programs for your drug
2. Download the application
3. Gather documents: last two pay stubs or tax return, proof of address, doctor’s note
4. Mail or submit online
5. Wait 2-4 weeks for approval

Many patients give up after the first application. But persistence pays. One woman in Ohio applied to five different PAPs for her son’s rare disease medication. Three denied her. The fourth approved her-and now she gets the drug free every three months.

What You Need to Know Before You Apply

- Not all programs work with all pharmacies. Some only ship to your home. Others only work with CVS, Walgreens, or specific chains.

- Renewals are common. Most PAPs require you to reapply every 6-12 months. Set a calendar reminder.

- Doctors can help. Many clinics have patient navigators who handle applications for you. Ask.

- Don’t assume you’re ineligible. Even if you have a job, you might still qualify. Income limits are higher than you think.

- Watch for scams. Legitimate programs never ask for credit card info upfront. If someone calls asking for payment to “process” your application, hang up.

The Bigger Picture

These programs are lifesavers-but they’re also a symptom of a broken system. The fact that 28 million Americans are still uninsured, and millions more can’t afford their meds despite having insurance, shows that manufacturer assistance isn’t a solution. It’s a Band-Aid.

Pharmaceutical companies say they’re doing their part. And in many cases, they are. But without real price controls, these programs will keep growing. The Congressional Budget Office predicts that by 2028, over 15 million Americans will rely on manufacturer help just to get their prescriptions. That’s more than the population of Florida.

For now, if you’re struggling to pay for your meds, don’t wait. Start with the Medicine Assistance Tool. Talk to your pharmacist. Ask your doctor. You’re not alone-and help is out there.

Next Steps

If you’re paying more than $50 a month out of pocket for a prescription, take 10 minutes today and search the Medicine Assistance Tool. Even if you think you don’t qualify, it’s worth checking. Many people find help they didn’t know existed.

Ask your pharmacist: "Does this drug have a manufacturer copay card?" They often have the cards on hand. Talk to your doctor: "Are there patient assistance programs for this medication?" They can write the letter you need.

Don’t let confusion or shame stop you. These programs exist because people need them. You’re not asking for a handout-you’re using a tool designed to make healthcare work.