Patient assistance program (PAP)

A patient assistance program is run by a drug manufacturer and provides medication free or at deep discount to people who qualify, generally on the basis of household income and lack of adequate insurance coverage. It is distinct from a copay card, which reduces what an insured patient pays at the counter. A PAP supplies the drug itself.

Medicare’s own guidance points people toward these programs as one route when drug costs are unmanageable, alongside the Extra Help program for Part D enrollees and state pharmaceutical assistance programs. The federal and manufacturer routes are separate systems with separate applications.

Applications share a common shape: proof of income (typically tax returns or pay stubs), proof of residency, a statement that you lack coverage for the drug, and a section your prescriber completes. Eligibility is set as a percentage of the federal poverty level, the threshold differs by manufacturer and by program, and approvals are time-limited — recertification is usually required each year, and a change in income or insurance status can end enrollment mid-year.

Two things reliably trip people up. First, having insurance that excludes weight-management drugs is not the same as having no coverage, and programs differ on whether that counts — read the specific eligibility language rather than assuming. Second, enrollment in a federal program such as Medicare or Medicaid usually disqualifies you from manufacturer assistance, because federal anti-kickback rules bar drug companies from subsidizing beneficiaries of federal health programs.

Worth doing: apply before you run out, not after, because processing takes weeks; ask your prescriber’s office who handles these forms, since many practices have someone who does; and get the approval period and recertification date in writing. Our buyer guide for paying without insurance, savings calculator and manufacturer coupon entry compare the routes.