Frequently Asked Questions

For a complete listing of the Co-Pay Relief Program Terms and Conditions, please click here

To review the full Co-Pay Relief Program Disclaimer, please click here

CPR provides direct financial assistance with co-payments, co-insurance and deductibles required by the patient’s insurer for medications prescribed to treat and manage their disease.

Yes, our services are completely free.

As a charity, PAF is exempt from federal income tax and individuals who receive assistance from a charity to meet their personal needs do not generally have to pay federal income tax on the value of the assistance they receive. Therefore, it should not affect your ability to receive financial assistance from the government or affect your income taxes. This should not be considered tax advice, and we recommend you consult with a tax and/or benefits expert to confirm your particular situation.

To be eligible for support from CPR you must meet the following criteria:

• Have a diagnosis of a disease within our CPR Program
• Have a household Income at or below 400% or 500% of the Federal Poverty Guideline (FPG) with consideration for the Cost of Living Index (COLI) and number in the household
• Have active insurance coverage that includes coverage for pharmaceutical products

For more Information on the streamlined process for pharmacies and providers to verify the patient’s diagnosis and treatment plan, please select one of the following links:

Providers
Pharmacies

Yes, anyone can apply to the program on the patient’s behalf; however, the person completing the application is not the patient, he/she must sign  the application attesting to the fact that the patient has given him/her the authority to complete the application on behalf of the patient.

Having a grant from another foundation should not be used as an eligibility criterion and a way to exclude you from receiving assistance from any charitable co-pay assistance program as that is not consistent with OIG guidance.

Eligibility criteria for our program is consistent with OIG guidance for charitable patient assistance programs and includes verifying that the patient’s income, diagnosis and insurance are eligible for assistance using a uniform, verifiable and consistent process. As such, you can apply to our program for assistance. Having another grant from a charitable foundation or a manufacturer program does not make you ineligible for our program. We realize that some people need more help than one resource can provide, and our goal is to make sure patients have the financial support that is needed.

Please note that you cannot submit the same expense to our program that has been paid by another program as that would be considered a fraudulent claim.

Our staff will verify your diagnosis with your treating physician within 30 days of your approval for support. However, based on your application status, if we are unable to verify your reported income, we will send a letter requesting proof of income documentation be submitted to our program within 30 days for continued eligibility. Some of the reasons a patient would be selected for review include: Patients’ income appears to exceed program guidelines, social security number discrepancy, unable to locate patients’ information.

You will know immediately upon completion of the application if you are eligible for assistance. If you are applying online, you will be notified on the screen at the end of the application if you are approved for assistance. If you are applying over the phone, the CPR Approval Specialist will notify you immediately at the completion of the application if you are eligible for assistance.

For more Information on the streamlined process for pharmacies and providers to verify the patient’s diagnosis and treatment plan, please select one of the following links:
Providers
Pharmacies

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Approved (N): Patient is approved for assistance and income has been verified. Income documentation is not required and eligible expenditures may be submitted immediately.

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Pending-Review (Y): We are unable to verify your/the patient’s information provided on the application. Proof of income documentation must be submitted along with documentation verifying your/the patient’s Social Security Number (SSN) within 30 days in order to process your/the patient’s application. Eligible expenditures will not be processed until your/the patient’s income has been reviewed and approved.

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Pending-Income Verification: Patient’s income is still pending verification. Please check back later to determine if additional documentation needs to be submitted.

There are four easy ways to apply for assistance:

Your treating physician’s office can assist you with completing an application for assistance via the provider portal available 24 hours a day. Providers

Your pharmacy that is dispensing your prescribed medications can assist you with creating an application for assistance via the pharmacy portal available 24 hours a day. Pharmacies

You, or someone you designate to assist you, can create an application for assistance via the patient portal available 24 hours a day. Patients

Applications can also be completed over the phone by calling, toll free, 866-512-3861, and option 1, to be connected directly to a CPR Approval Specialist.

Our program accepts applications via our online application accessible on our website and by phone. Leaving a voice mail, sending an email request and/or faxing an application request are not acceptable methods to initiate an application.

Approved patients within CPR, their treating physicians, and/or the pharmacies dispensing their prescribed medication(s) are eligible to begin submitting claims immediately! Claims can be submitted via Virtual Pharmacy Card, online portal or via fax at any time.

The Virtual Pharmacy Card may be used at Pharmacies or Specialty Pharmacies by providing your card information:
Cardholder Number: Cardholder#
BIN: BIN Number
PCN: PCN Number
Group: Group #

Yes, the CPR program offers a 6 month “look back period” that begins on the date you are approved for assistance from the program. You, your treating physician, and/or the pharmacy that is dispensing your prescribed medications can submit outstanding bills for outstanding charges related to the pharmaceutical products that have been prescribed to treat and manage your illness.

CPR has the ability to make payments directly to your treating physician, the pharmacy that is dispensing your prescribed medications and/or reimburse you for out-of-pocket expenses you have incurred for pharmaceutical products prescribed to treat and manage your disease. For detailed information, click here: Guide to Expenditure Payments.

Yes, Patients approved for assistance are expected to utilize their award. If you exceed 120 consecutive days with no processed claims at any time during your 12-month award period, you will forfeit your award and are not eligible to reapply for the program until 12 months from the original date of approval.

Our award is for a 12 month period. Should you exhaust your award before that time, you must wait 12 months from the date you were approved before you are eligible to re-apply for additional assistance.

CPR can assist the patient provided the application for assistance was approved prior to the date the patient passed away.

Our program operates on a first-come, first-served basis as long as funding is available; therefore, we do not have a waiting list.

All applicants are required to have current health insurance or have had such coverage in the past 6 months to be eligible for assistance.

No, CPR is unable to make payments for pharmaceutical treatments and/or prescription medications relative to your diagnosis that are not covered by your health insurance.

Yes, all payments that are made on your behalf for pharmaceutical products prescribed to treat and manage your disease and is covered by your Medicare Part D plan will be counted towards your true out-of-pocket costs (TrOOP) for the calendar year. CPR can make payments while you are in the coverage gap, also known as the “doughnut hole”, up to the amount of your annual award through the program.

Yes, CPR can assist with the share of cost or spend down if the cost of your pharmaceutical treatments and/or prescription medications meets or exceeds the share of cost or spend down amount each month.

The Patient Advocate Foundation Co-Pay Relief Program grants now can be used to pay for medical insurance premiums in addition to medication copays for the following funds: COVID-19, Cystic Fibrosis and HIV, AIDs & Prevention.

Please select the link below for more information regarding medical insurance premium assistance and how to submit.

Guide to Medical Insurance Premium Assistance

CPR is not drug specific, rather, we assist with co-payments, co-insurance, and deductibles for all pharmaceutical products prescribed for the treatment and management of your disease as long as the products are covered by your insurance plan.

No, medical services including, but not limited to, lab work, office visits, surgeries, radiation therapy and scans are not eligible expenses under the program.

You can only apply for assistance in one disease fund per award year.

All applicants are required to be currently in treatment, planning to begin treatment in the next 60 days or have been in treatment in the past 6 months.

Yes, PAF was issued Advisory Opinion #04-15 in 2004 that provided guidance and approval for PAF to establish and administer the Co-Pay Relief Program.

First, PAF would like to say, “Thank you!” If you would like to make a donation online using our secure form, please click here – OR – Mail your donation via check or money order to our corporate office at 421 Butler Farm Road, Hampton, VA 23666. Please make checks payable to Patient Advocate Foundation. For more information, you may contact PAF at 1-800-532-5274.