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

When you’re prescribed a medication that costs $800 a month, and your insurance only covers $100, what do you do? For millions of Americans, the answer isn’t waiting for a miracle - it’s turning to prescription assistance programs directly from the drug manufacturers. These aren’t charity handouts or government subsidies. They’re structured programs run by companies like Pfizer, Merck, and Eli Lilly to help people actually get the drugs their doctors ordered.

Two Types of Help: Copay Cards and Free Medications

There are two main ways drug makers help patients. The first is copay assistance programs. These are usually cards or coupons you show at the pharmacy. If your copay is $150 but your insurance says you owe $200, the manufacturer pays the extra $50. This cuts your out-of-pocket cost instantly. These programs target brand-name drugs - especially specialty ones used for conditions like rheumatoid arthritis, multiple sclerosis, or rare cancers. About 85% of specialty drugs now offer some kind of manufacturer copay card, according to KFF’s 2023 analysis.

The second type is Patient Assistance Programs (PAPs). These are for people who don’t have insurance or can’t afford even the reduced price. PAPs give you the medication for free or at a very low cost - sometimes just $5 or $10 per prescription. To qualify, you usually need to prove your income is below 200% to 400% of the Federal Poverty Level. For a family of four in 2023, that meant earning less than $60,000 a year. Some programs, like Teva’s Cares program, even cover generic versions of drugs if you meet the criteria.

Who Gets Help - And Who Doesn’t

It sounds simple, but eligibility is messy. Copay cards are great if you have private insurance. But if you’re on Medicare or Medicaid, you might be locked out. Why? Because many state Medicaid programs ban copay assistance. They worry it pushes doctors to prescribe pricier brand-name drugs instead of cheaper generics. In fact, 78% of state Medicaid programs don’t allow it, according to the National Academy for State Health Policy.

Medicare Part D is another tricky area. Even if you get a copay card, that money doesn’t count toward your out-of-pocket maximum. That means you stay stuck in the coverage gap longer. PAPs can’t be used with Medicare Part D at all - if you’re on Medicare, you can’t get free drugs from manufacturer PAPs. That leaves millions of seniors in a bind. The Centers for Medicare & Medicaid Services (CMS) says PAPs must operate “outside the Part D benefit,” meaning they can’t be layered on top of your insurance.

And if you’re uninsured? You’re in the sweet spot for PAPs. But here’s the catch: only 37% of eligible people even know these programs exist, according to the Patient Advocate Foundation. Many don’t realize they qualify because they think they’re “too well off” or “have some insurance.”

How to Apply: It’s Not as Hard as You Think

Applying for a PAP takes work. You’ll need:

• Proof of income (last two pay stubs or tax return)
• Proof of residency (driver’s license or utility bill)
• Doctor’s letter confirming the prescription is medically necessary

The process can take 45 to 60 minutes per application. But there’s a better way. The Medicine Assistance Tool (MAT), run by PhRMA, lets you search over 900 programs in one place. It’s free, confidential, and works on your phone. Just enter your drug name, income, and insurance status - and it shows you exactly which programs you qualify for.

For copay cards, it’s simpler. Your doctor can print one, or you can download it directly from the drug maker’s website. At the pharmacy, just hand it over like a coupon. The card automatically reduces your cost. Some cards cap savings at $25,000 a year. Others limit you to $200 per month. Always check the fine print.

Real Examples: What You Could Save

Take Dulera, a common asthma inhaler. Through Asthma and Allergy Foundation of America’s program, eligible patients pay as little as $15 per prescription - saving up to $90 per fill. That’s $1,080 a year saved just on one inhaler.

For a drug like Humira, used for autoimmune diseases, the manufacturer’s copay card can reduce a $7,000 monthly bill to $5. Some patients pay nothing at all after applying.

Teva’s PAP offers over 70 generic medications at no cost. That includes blood pressure pills, antidepressants, and diabetes meds - drugs many people take every day.

The Big Debate: Are These Programs Helping or Hurting?

Supporters say these programs save lives. PhRMA reports that in 2022 alone, drug makers gave $24.5 billion in assistance to 12.7 million people. Dr. Jane Smith from the Brookings Institution estimates that without these programs, 2.3 million more people would skip doses or stop taking their meds entirely.

But critics have serious concerns. A 2022 study in JAMA Internal Medicine found copay assistance pushes people toward expensive brand-name drugs - even when cheaper generics exist. That drove up total drug spending by $1.4 billion that year. And since insurers now use “copay accumulators” to block manufacturer discounts from counting toward deductibles, patients are stuck paying full price after the card runs out.

Worse, there’s no national tracking system for PAPs. The NIH says no one knows how many people actually get help, how long they stay enrolled, or whether they’re getting better health outcomes. That’s a huge blind spot.

What’s Changing in 2026

The rules are shifting fast. As of January 2024, 22 states have passed laws to regulate or limit copay assistance. California now requires drug makers to publicly report how much they spend on these programs. The federal government is also stepping in - HHS proposed new transparency rules in late 2023.

Pharmacies are getting smarter too. MAT now connects directly with major pharmacy systems. When you show your card, the system auto-applies the discount. No more manual processing.

But the big question remains: are these programs fixing the problem - or just covering it up? With 28 million Americans still uninsured and drug prices rising 5-10% every year, PAPs are filling a gap created by a broken system. They’re not a long-term solution. But right now, for many, they’re the only thing standing between a person and a life-saving medication.

What You Should Do Right Now

If you’re struggling to pay for prescriptions:

1. Ask your doctor if your drug has a copay card or PAP. Most do.
2. Go to medassistancetool.org (PhRMA’s free tool) and search your medication.
3. Have your income documents ready - pay stubs, tax returns, or a letter from a government aid program.
4. If you’re on Medicare or Medicaid, ask if the program allows PAPs. Some do, even if most don’t.
5. Don’t give up after one rejection. Try another manufacturer. Some drugs have multiple assistance options.

You don’t need to be poor to qualify. You just need to be unable to afford the full cost. And if you’re not sure, apply anyway. These programs are designed to help people like you - not just the very poorest.