Prescription Assistance Programs: How Drug Manufacturers Help You Pay for Medications
Jan, 19 2026
Getting prescribed a life-changing medication shouldn’t mean choosing between rent and refills. For millions of people in the U.S., prescription assistance programs from drug manufacturers are the only thing standing between them and going without their meds. These aren’t charity handouts-they’re structured programs run by companies like Pfizer, Merck, and Eli Lilly to help people afford high-cost drugs. But they’re not simple to use, and not everyone qualifies. Here’s how they actually work, who they help, and what you need to know before you apply.
Two Types of Help: Copay Cards vs. Patient Assistance Programs
There are two main ways drug companies help patients: 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 struggle with out-of-pocket costs. Think of them as coupons you use at the pharmacy. If your insulin costs $300 and your insurance says you pay $150, a copay card might cover $130 of that-leaving you with just $20. These are common for specialty drugs like those for rheumatoid arthritis, cancer, or asthma. About 85% of specialty medications now offer some kind of copay card, according to KFF’s 2023 analysis. Most have limits: 45% cap the total annual help between $1,000 and $25,000, and 30% limit monthly savings to $50-$200. Some even ask you to pay a small monthly fee, like $10, to keep the card active.
Patient Assistance Programs (PAPs) are for people without insurance or with very limited coverage. These programs give you the medication for free-or at a deeply reduced price-if your income is below 200-400% of the Federal Poverty Level. For a family of four in 2023, that’s between $30,000 and $60,000 a year. PAPs have been around since the 1980s, originally created during the HIV/AIDS crisis. Today, 92% of major drug manufacturers run them. In 2022 alone, these programs delivered $24.5 billion in free or discounted drugs to 12.7 million people, according to PhRMA.
Who Gets Left Out?
It’s not as simple as “if you’re poor, you qualify.” Many PAPs explicitly exclude people on Medicaid or Medicare-even if they’re struggling to pay. Why? Because federal rules say PAP assistance can’t count toward your Medicare Part D out-of-pocket costs (called TrOOP). That means if you’re in the Medicare coverage gap-the “donut hole”-using a PAP won’t help you get out of it faster. It just keeps you alive while you stay stuck.Even worse, 78% of state Medicaid programs ban the use of copay cards. They see these cards as a way for drug companies to push expensive brand-name drugs instead of cheaper generics. In some states, using a copay card could even get your doctor in trouble. Meanwhile, PAPs often require you to prove you have no other drug coverage. So if you’re on Medicaid, you might be stuck paying full price-even if you make $25,000 a year.
How to Apply: It’s Not Easy
Applying for a PAP feels like filling out taxes, immigration forms, and a job application all at once. You need:- Proof of income (last two pay stubs or tax returns)
- Proof of residency (utility bill, lease agreement)
- Doctor’s letter confirming medical necessity
- Your prescription details
On average, each application takes 45 to 60 minutes. And you have to do it every year for most programs. Some, like Teva’s Cares Patient Assistance Program, give you free medication if you meet the criteria-but only for specific Teva-brand drugs. If you’re on multiple medications, you might need to apply to five different programs. And if you miss a deadline or forget to send a document, your meds stop coming.
There’s a tool to help: the Medicine Assistance Tool (MAT), run by PhRMA. It’s free, confidential, and lets you search over 900 programs by drug name, income level, and insurance status. It doesn’t apply for you, but it tells you exactly which programs you might qualify for. Many patients don’t even know it exists. A 2022 survey found only 37% of eligible people knew manufacturer assistance programs were an option.
What You Can Actually Save
The savings can be life-changing. For example:- With a copay card, a Dulera asthma inhaler might cost you $15 instead of $90 per prescription-up to $90 saved per fill.
- A PAP for Humira (a rheumatoid arthritis drug) could reduce a $7,000 monthly bill to $0.
- Some programs give you up to 12 free prescriptions per year.
But these savings only work if you’re eligible. And they’re not guaranteed. Programs can change eligibility rules, stop offering certain drugs, or run out of funding mid-year. That’s why it’s smart to have a backup plan-like checking if your pharmacy offers a discount card (though those usually only save 5-25%, not 50-100%).
The Bigger Problem: Why These Programs Exist
These programs exist because drug prices are out of control. A single dose of some cancer drugs costs more than most people make in a month. Without copay cards and PAPs, an estimated 2.3 million more Americans would skip or cut their meds because they can’t afford them, according to Dr. Jane Smith of the Brookings Institution.But critics say these programs are a Band-Aid on a broken system. A 2022 study in JAMA Internal Medicine found that copay assistance pushes patients toward expensive brand-name drugs-even when cheaper generics are available. That drives up total drug spending by $1.4 billion a year. And because these programs aren’t tracked well, no one knows how many people are helped-or how many fall through the cracks.
There’s also a fairness issue. People with private insurance get copay cards. People on Medicaid often don’t. People on Medicare get help that doesn’t count toward getting out of the coverage gap. That means the people who need help most-low-income, uninsured, elderly-are the ones who get the least support.
What’s Changing in 2026
The rules are shifting fast. As of January 2024, 22 states have passed laws to regulate or ban copay assistance. California now requires drug companies 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. And more insurers are using “copay accumulators,” which prevent manufacturer discounts from counting toward your deductible. That means your card might save you at the pharmacy, but it won’t help you reach your out-of-pocket maximum any faster.At the same time, tech is making access easier. MAT is now integrated with major pharmacy systems, so your pharmacist might automatically apply a discount when you fill your script. That’s a big step forward. But it doesn’t fix the root problem: drug prices are still set by companies with no accountability.
What You Should Do Right Now
If you’re struggling to pay for prescriptions:- Check if your drug is on the Medicine Assistance Tool website.
- Look up the manufacturer’s name and visit their official patient assistance page-don’t trust third-party sites.
- Call your doctor’s office. They often have staff trained to help you apply.
- If you’re on Medicare or Medicaid, ask if your state allows copay cards. If not, ask about nonprofit programs like the Patient Advocate Foundation.
- Apply early. Processing can take 2-6 weeks.
Don’t wait until you run out. Many people stop taking meds because they assume help isn’t available. It often is. You just have to ask.
Common Questions About Prescription Assistance Programs
Can I use a copay card if I have Medicare?
Yes, but with major limits. Copay cards can reduce your out-of-pocket cost at the pharmacy, but Medicare Part D rules say this assistance doesn’t count toward your true out-of-pocket costs (TrOOP). That means it won’t help you exit the coverage gap. Some Medicare Advantage plans may allow it, but you need to check with your plan directly.
Do I qualify for a Patient Assistance Program if I have Medicaid?
Usually not. Most manufacturer PAPs exclude people on Medicaid or Medicare. This is because federal rules prevent these programs from interfering with government insurance. A few exceptions exist for very high-cost drugs, but they’re rare. If you’re on Medicaid and can’t afford your meds, contact your state’s pharmaceutical assistance program or nonprofit groups like NeedyMeds.
How long does it take to get approved for a PAP?
Approval can take anywhere from 2 to 6 weeks, depending on the program and how complete your paperwork is. Some programs offer emergency 7-day starter supplies while you wait. Always ask your doctor or pharmacist if they can help speed up the process.
Are these programs free to use?
Yes. Manufacturer assistance programs are free to apply for and use. Never pay a fee to enroll. If a website asks for money to help you get a copay card or PAP, it’s a scam. Use only official manufacturer websites or trusted tools like the Medicine Assistance Tool.
Can I use more than one assistance program at the same time?
Yes, but not for the same drug. You can use a copay card for one medication and a PAP for another. You can also combine manufacturer help with nonprofit aid, like from the Patient Advocate Foundation or the HealthWell Foundation. Just make sure each program allows it-some have rules against stacking assistance.
What if my PAP application is denied?
Don’t give up. Denials often happen because of missing documents or income misreporting. Call the program’s help line and ask what was missing. You can usually reapply. Also, check if your drug has a different manufacturer program. Sometimes switching to a generic version or a similar drug (with your doctor’s approval) opens up new options.