Special Patients In Need

What is Special Patients In Need?

Our company was originally formed by a nurse in 1999 to help people who cannot afford to pay for their medications.  She named the company Special Patients In Need (S.P.I.N.) S.P.I.N. Works with United Way, Division of Family and Children Services (DFCS), doctors, hospitals, pharmaceutical companies, and several other agencies across the county to help people who cannot afford to pay for their medications.  Before she formed the company she was working as a nurse for a doctor in Moultrie, Georgia. She had many responsibilities while working as a nurse including qualifying their patients through pharmaceutical companies' Patient Assistance Programs.  After several years of this she decided to go out on her own to form a company to help patients receive their medications when they were financially unable to pay for them.  She sold the company to a corporation in Atlanta Georgia many years ago.  Before she sold the company she made certain that this corporation had nurses and other medical professionals who knew the ins-and-outs of qualifying patients through the Patient Assistance Programs.  She also made certain that they also knew how to qualify patients who were enrolled in Medicare “D” prescription coverage.  Now there are thousands of nurses and other medical professionals all across the country working for Special Patients In Need.

What are patient assistance programs? 

The Patient Assistance Program (PAPs) is a program that the pharmaceutical companies offer to help you with your medication if you cannot afford to pay for it.  These patient assistance programs are programs set up by drug companies that offer free or low cost drugs to individuals who are unable to pay for their medication.  These programs may also be called indigent drug programs, charitable drug programs, or medication assistance programs.  Most of the best known and most prescribed drugs can be found in these programs.  All of the major drug companies have patient assistance programs, although every company has different eligibility and application requirements.  Pharmaceutical companies offer these programs voluntarily; the government does not require them to provide free medicine Age is not a factor in order to qualify.

What are the eligibility requirements for patient assistance programs?

Millions of people are already benefiting from patient assistant programs - and there are millions more who could be helped.

Eligibility varies program by program.  Generally, individuals must have incomes under 200% of the Federal Poverty Level, cannot have prescription coverage from any public or private source, and must be a U.S. resident or citizen.  Some pharmaceutical companies require that the patient have no health insurance and not be enrolled in the federal government’s Medicare “D” prescription drug program.

Income: (2012 FPL Guidelines)

To qualify for most patient assistance programs, your total household income must be less than 200% of the Federal Poverty Level. Some programs are 300% or lower.

Prescription Coverage:

Prescription assistance programs require that you do not currently subscribe to private or public sources of prescription coverage or that your prescription coverage has reached its annual limit.

Residence:

You must be a United States resident or citizen to be eligible for any of these programs.

Each pharmaceutical company will have their own eligibility requirements. Income and lack of prescription drug coverage is normally the most important criteria for determining whether someone can enroll. The patient also must not qualify for any third party coverage, such as a state or federal program that would cover the cost of their medicine including Medicare “D” regardless if the patient is in their donut-hole or not.

Individual's income criteria vary with family incomes ranging from below the poverty level to up to $ 60,000. These are for medications that are used to treat things such as Multiple Sclerosis, Aids, Cancer, or other rare disorders. Medications for these specific illnesses are extremely expensive and are therefore subject to different guidelines by the companies that manufacture them.

Other factors such as number of people in the household and total medical cost may also be considered.

What questions will applicants be prompted to answer?

You should be prepared to provide the following questions regarding yourself and your medications:

• Name
• Address
• City, State of residence and ZIP code
• Whether or not you are a US citizen
• Date of birth
• Telephone number(s)
• Social Security Number
• Estimated gross annual household income of each person living in the household
• Number of people living in household
• Brand name of prescription medicines that you are currently taking or have been prescribed along with each medicines milligrams and how often per day you take each medicine
• Any allergies that you may have to medicines
• Type of health insurance and/or prescription coverage (if applicable) including whether or not you are enrolled in Medicare “D” prescription coverage

 Your responses to these questions are completely confidential.

What other documents are needed in addition to the above information?

It may be required that your physician provide additional information besides what was requested of us.  In most cases, your physician will be required to provide a prescription for the specific medication, doctor’s information, along with their signature.

Can I apply if I am enrolled in Medicare “D” prescription coverage?

Most patient assistance programs disqualify all those eligible for the full low income subsidy through Medicare Part D. If you do not qualify for the full low income subsidy, you should attach documentation to your application from Social Security Administration stating that you are ineligible. This information varies greatly between different companies and is subject to change without notice. It is not uncommon for exceptions to be made for those facing financial difficulties.

Can my application be rejected by the pharmaceutical companies that manufacture my medications?

Unfortunately not every application to a patient assistance program will be accepted. As these services are provided for free by the pharmaceutical companies, it is at their discretion who they reject and for what reason. It is unlikely that you will be disqualified for anything other than failing to meet all eligibility requirements.  It is possible to have the rejection overturned by submitting your application for appeal.

Is every medication available free?

Unfortunately No.  Normally only brand name products have programs. This is because they are more expensive and have no generic available on the market. Once they go off patent and the patient can now buy it for a fraction of the brand name cost, the company that manufactures the brand name has no reason to make it available for free. Once the medication goes off patent and out of the programs, they normally are sold for as low as four dollars for a month’s supply through many pharmacies such as Wal-Mart pharmacy, Walgreens, CVS, etc.

Where do the medications come from?

The medications are supplied and sent to your doctor (in some cases they are delivered directly to the patient) directly from the drug manufacturer and are normally filled for a 90 day supply.

What do I have to do to apply for a patient assistance program?

The majority of the pharmacy companies have applications that must be completed and signed by both the patient and the doctor.   All you have to do is contact our office, that’s all.  We do the rest.  When you contact us, we can determine if you qualify over the phone in just minutes.  We will ask you if you have any prescription drug coverage and if you are enrolled in Medicare “D” prescription drug program, veteran's status, eligibility for public insurance programs and income and asset information.  We will also ask for:

  •  Proof of income, such as federal income tax statements or pay stubs                

  • Medicaid or insurance denial letters

  • A prescription from your doctor

  • Patient consent forms that is included with the application.

Most applications will request information about your physician.

Applications may require the signature of the physician, the patient, or both.

The physician's office will include either specific prescription information or an actual prescription to be sent along with the application to our office. We will either mail or fax the application to the pharmaceutical company in accordance with their specific instructions.

How long does it take for my medicine to arrive?

While companies are committed to getting free or nearly free prescription medicines to eligible patients as quickly as possible, each participating patient assistance program has its own timeline.

It can take anywhere from four to six weeks for medication to arrive after approval for participation in the program once our fee has been paid.  In most cases, the pharmaceutical companies will deliver the patient’s medications directly to the patient’s doctor once the applications have been processed. In very few circumstances the pharmaceutical companies will deliver the patient’s medications directly to the patient.

I have health insurance, but no prescription insurance; am I eligible for patient assistance programs?

In most cases, the answer is yes.

I have coverage for prescriptions with my health insurance but I have reached my coverage limit.  Am I eligible for patient assistance programs?

Technically, if you have reached your coverage limit you no longer have prescription coverage, but we suggest attaching a letter with your application that indicates this.  If you have a letter from your insurer stating that you have used up your benefits, send that along as well.

Can Medicare and Medicaid beneficiaries qualify?

Each patient assistance program has its own eligibility criteria. Many programs provide prescription assistance for Medicare beneficiaries who do not have full prescription drug benefits. People who are enrolled in other public and privately sponsored programs that include prescription drug coverage may not be eligible for assistance; however, there are some instances in which Medicaid beneficiaries may be eligible for certain patient assistance programs.

Can I join a patient assistance program and also have a Medicare approved drug discount card?

Yes, there may be some patient assistance programs for which you may be eligible.

Why am I eligible for patient assistance programs for some medicines, but not others?

The eligibility criteria for patient assistance programs vary from program to program and may even vary by medicines within a program, depending upon several factors related to your income, prescription medicines, resident state, age, and current prescription drug coverage.

How is the medication sent to the patient?

Depending on the pharmaceutical company, and the type of medication, it will either be sent to the physician's office, or directly to the patient's house. Some may send a voucher that is taken to your local pharmacy and redeemed. We advise you of the specific information on how your medication(s) is dispensed.

If applying for more than one medication, the patient should be aware that they would arrive at different times, since it is manufactured and sponsored by different companies. Normally a three-month supply is sent each time.

How long can the patient get their medications through these programs?

Most companies are helping patients by allowing for refills. Some have limits of only a three- month supply, while others allow the patient to apply indefinitely. Some have applications that are only renewed once a year, while others require a new one every three months. Refills are not sent automatically.  For the most part, pharmaceutical companies send the patient their medications in three months increments.

What does Special Patients In Need charge for their services? 

As described above, the medications come free from the pharmaceutical companies.  We charge a very nominal fee so the patient can receive their medications.  Usually, the patient will receive a year’s supply of each of their medications.  You are paying us to complete all the applications that the pharmaceutical companies require so you can receive your medications.  We also ensure that you are current on your medications. The patient can pay for their medications using their PayPal account or they can pay for their medications using their Credit Card or their Debit Card. 

Can you give me information about specific drugs?

Special Patients In Need was created to make it easier for low-income uninsured patients to get free or nearly free prescription medicines through existing patient assistance programs, while providing the highest level of service. The best way to find out about a specific drug is to consult your doctor or pharmacist.