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A Co-Payment Assistance Program for Insured Patients

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A Co-Payment

Assistance Program

for Insured Patients

Providing Critical

Financial Support for Patients

Are your services free?

Yes, our services are completely free. As a public charity, we are committed to helping patients with complex situations.

Can anyone, other than the patient,

apply to the program?

Yes, anyone can apply for assistance on the patient’s behalf; however, the patient, a legal guardian or an individual with power of attorney must ultimately sign

the application.

I have health insurance but it does

not cover my treatment and/or

medications. Can CPR help?

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.

What medications does the program cover?

Our program is not drug specific.

We assist with co-payments, co-insurance and deductibles for both curative and supportive pharmaceutical treatments and/or medications prescribed for your diagnosis as long as the products are covered by your insurance policy.

I would love to donate to your program.

What do I need to do?

First, PAF would like to say “Thank you!” If you would like to make a donation online, please visit our foundation’s website at www.patientadvocate.org/donate.

Since the launch of the Co-Pay Relief program in 2004, we have adhered to a set of guiding principles that have created a secure, supportive and sustainable patient service. These principles remain our compass for the future evolution of the program.

Patient-Centric | Efficient | Comprehensive Supportive | Compassionate | Compliant

Program Compliance

As a pioneer in the field of co-payment support programs, we not only operate our program in compliance with the guidance provided by the Office of Inspector General (OIG), but we hold ourselves to the higher standard of keeping the needs of the patients we serve at the center of all programmatic decision making. Our program is one of the only fully OIG-compliant methods to support the prescription drug co-payment and insurance premium costs that are incurred by patients who are insured by government-sponsored plans including Medicare, Tricare and Medicaid.

CPR is an Office of Inspector General approved co-payment assistance program for insured Americans offered through Patient Advocate Foundation. PAF is a 501(c)(3) non-profit organization that provides professional case management services to Americans with chronic, life-threatening and debilitating illnesses.

Q.

Q.

Q.

Q.

Q.

A.

A.

A.

A.

A.

Scan for a

full list of FAQs

Toll Free: 1-800-532-5274 |www.patientadvocate.org

help@patientadvocate.org | Tax ID #54-1806317 Toll Free: 1-866-512-3861 | www.copays.org

Fax: 757-952-0119 | cpr@patientadvocate.org

© Patient Advocate Foundation

(2)

Applying is Easy and Convenient

You

,

a friend or family member can apply for assistance via the patient portal at www.copays.org/patients

Your Treating Physician

can assist you with submitting the application for assistance via the provider portal at www.copays.org/providers

Your Pharmacy

dispensing the prescribed medications can assist you with the application for assistance via the pharmacy portal at www.copays.org/pharmacy

Our Program Specialists

can be reached toll free at 1-866-512-3861 and will personally guide you through the enrollment process

1-866-512-3861

|

www.copays.org

Eligibility Requirements

• Patients must be insured and have

insurance coverage for the medication(s) for which they seek assistance

• Patients must have a qualifying, verified

diagnosis of the disease or condition for which they seek financial assistance

• Patients must reside and receive treatment

in the United States

• Patient’s income must fall at or below 400%

of the Federal Poverty Guideline (FPG) with consideration of the Cost of Living Index and number in the household

Access Financial Assistance

Simply and Efficiently

Patient Advocate Foundation’s (PAF) Co-Pay Relief Program (CPR) is a free service that provides direct financial support to medically and financially qualified, insured patients, including those covered by

government-sponsored plans Medicare, Tricare and Medicaid, for co-payments, co-insurance and deductibles related to pharmaceutical treatments and prescription medications.

Receive a Personalized

Patient Experience

We are committed to helping patients get and stay on therapy. To insure that patients receive the right amount of assistance at the right time, our program specialists work directly with the patient, provider of care and pharmacy to complete the simple, streamlined application and provide a rapid eligibility decision.

• User-friendly online application portals

• Easy documentation of income and diagnosis

• Live Spanish language services

• Rapid qualification determination

• Look-back period for recently

incurred expenses

• Payments may be directed to the provider,

pharmacy or patient

“Not only was I struggling with trying to beat

this horrible disease, I was also carrying a very

heavy burden of trying to stay above water

while the bills kept rolling in… To have even just

part of what I owed paid for, brought me

to tears. This was the best news that I could

have heard. A little calm in my storm.”

Suzanne N.

Consistently selected by oncology practice managers

as the best co-pay foundation for helping patients.

Oncology Market Access, U.S.

(3)

Applying is Easy and Convenient

You

,

a friend or family member can apply for assistance via the patient portal at www.copays.org/patients

Your Treating Physician

can assist you with submitting the application for assistance via the provider portal at www.copays.org/providers

Your Pharmacy

dispensing the prescribed medications can assist you with the application for assistance via the pharmacy portal at www.copays.org/pharmacy

Our Program Specialists

can be reached toll free at 1-866-512-3861 and will personally guide you through the enrollment process

1-866-512-3861

|

www.copays.org

Eligibility Requirements

• Patients must be insured and have

insurance coverage for the medication(s) for which they seek assistance

• Patients must have a qualifying, verified

diagnosis of the disease or condition for which they seek financial assistance

• Patients must reside and receive treatment

in the United States

• Patient’s income must fall at or below 400%

of the Federal Poverty Guideline (FPG) with consideration of the Cost of Living Index and number in the household

Access Financial Assistance

Simply and Efficiently

Patient Advocate Foundation’s (PAF) Co-Pay Relief Program (CPR) is a free service that provides direct financial support to medically and financially qualified, insured patients, including those covered by

government-sponsored plans Medicare, Tricare and Medicaid, for co-payments, co-insurance and deductibles related to pharmaceutical treatments and prescription medications.

Receive a Personalized

Patient Experience

We are committed to helping patients get and stay on therapy. To insure that patients receive the right amount of assistance at the right time, our program specialists work directly with the patient, provider of care and pharmacy to complete the simple, streamlined application and provide a rapid eligibility decision.

• User-friendly online application portals

• Easy documentation of income and diagnosis

• Live Spanish language services

• Rapid qualification determination

• Look-back period for recently

incurred expenses

• Payments may be directed to the provider,

pharmacy or patient

“Not only was I struggling with trying to beat

this horrible disease, I was also carrying a very

heavy burden of trying to stay above water

while the bills kept rolling in… To have even just

part of what I owed paid for, brought me

to tears. This was the best news that I could

have heard. A little calm in my storm.”

Suzanne N.

Consistently selected by oncology practice managers

as the best co-pay foundation for helping patients.

Oncology Market Access, U.S.

Kantar Health

(4)

Applying is Easy and Convenient

You

,

a friend or family member can apply for assistance via the patient portal at www.copays.org/patients

Your Treating Physician

can assist you with submitting the application for assistance via the provider portal at www.copays.org/providers

Your Pharmacy

dispensing the prescribed medications can assist you with the application for assistance via the pharmacy portal at www.copays.org/pharmacy

Our Program Specialists

can be reached toll free at 1-866-512-3861 and will personally guide you through the enrollment process

1-866-512-3861

|

www.copays.org

Eligibility Requirements

• Patients must be insured and have

insurance coverage for the medication(s) for which they seek assistance

• Patients must have a qualifying, verified

diagnosis of the disease or condition for which they seek financial assistance

• Patients must reside and receive treatment

in the United States

• Patient’s income must fall at or below 400%

of the Federal Poverty Guideline (FPG) with consideration of the Cost of Living Index and number in the household

Access Financial Assistance

Simply and Efficiently

Patient Advocate Foundation’s (PAF) Co-Pay Relief Program (CPR) is a free service that provides direct financial support to medically and financially qualified, insured patients, including those covered by

government-sponsored plans Medicare, Tricare and Medicaid, for co-payments, co-insurance and deductibles related to pharmaceutical treatments and prescription medications.

Receive a Personalized

Patient Experience

We are committed to helping patients get and stay on therapy. To insure that patients receive the right amount of assistance at the right time, our program specialists work directly with the patient, provider of care and pharmacy to complete the simple, streamlined application and provide a rapid eligibility decision.

• User-friendly online application portals

• Easy documentation of income and diagnosis

• Live Spanish language services

• Rapid qualification determination

• Look-back period for recently

incurred expenses

• Payments may be directed to the provider,

pharmacy or patient

“Not only was I struggling with trying to beat

this horrible disease, I was also carrying a very

heavy burden of trying to stay above water

while the bills kept rolling in… To have even just

part of what I owed paid for, brought me

to tears. This was the best news that I could

have heard. A little calm in my storm.”

Suzanne N.

Consistently selected by oncology practice managers

as the best co-pay foundation for helping patients.

Oncology Market Access, U.S.

(5)

A Co-Payment

Assistance Program

for Insured Patients

Providing Critical

Financial Support for Patients

Are your services free?

Yes, our services are completely free. As a public charity, we are committed to helping patients with complex situations.

Can anyone, other than the patient,

apply to the program?

Yes, anyone can apply for assistance on the patient’s behalf; however, the patient, a legal guardian or an individual with power of attorney must ultimately sign

the application.

I have health insurance but it does

not cover my treatment and/or

medications. Can CPR help?

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.

What medications does the program cover?

Our program is not drug specific.

We assist with co-payments, co-insurance and deductibles for both curative and supportive pharmaceutical treatments and/or medications prescribed for your diagnosis as long as the products are covered by your insurance policy.

I would love to donate to your program.

What do I need to do?

First, PAF would like to say “Thank you!” If you would like to make a donation online, please visit our foundation’s website at www.patientadvocate.org/donate.

Since the launch of the Co-Pay Relief program in 2004, we have adhered to a set of guiding principles that have created a secure, supportive and sustainable patient service. These principles remain our compass for the future evolution of the program.

Patient-Centric | Efficient | Comprehensive Supportive | Compassionate | Compliant

Program Compliance

As a pioneer in the field of co-payment support programs, we not only operate our program in compliance with the guidance provided by the Office of Inspector General (OIG), but we hold ourselves to the higher standard of keeping the needs of the patients we serve at the center of all programmatic decision making. Our program is one of the only fully OIG-compliant methods to support the prescription drug co-payment and insurance premium costs that are incurred by patients who are insured by government-sponsored plans including Medicare, Tricare and Medicaid.

CPR is an Office of Inspector General approved co-payment assistance program for insured Americans offered through Patient Advocate Foundation. PAF is a 501(c)(3) non-profit organization that provides professional case management services to Americans with chronic, life-threatening and debilitating illnesses.

Q.

Q.

Q.

Q.

Q.

A.

A.

A.

A.

A.

Scan for a

full list of FAQs

Toll Free: 1-800-532-5274 |www.patientadvocate.org

help@patientadvocate.org | Tax ID #54-1806317 Toll Free: 1-866-512-3861 | www.copays.org

Fax: 757-952-0119 | cpr@patientadvocate.org

© Patient Advocate Foundation

(6)

A Co-Payment

Assistance Program

for Insured Patients

Providing Critical

Financial Support for Patients

Are your services free?

Yes, our services are completely free. As a public charity, we are committed to helping patients with complex situations.

Can anyone, other than the patient,

apply to the program?

Yes, anyone can apply for assistance on the patient’s behalf; however, the patient, a legal guardian or an individual with power of attorney must ultimately sign

the application.

I have health insurance but it does

not cover my treatment and/or

medications. Can CPR help?

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.

What medications does the program cover?

Our program is not drug specific.

We assist with co-payments, co-insurance and deductibles for both curative and supportive pharmaceutical treatments and/or medications prescribed for your diagnosis as long as the products are covered by your insurance policy.

I would love to donate to your program.

What do I need to do?

First, PAF would like to say “Thank you!” If you would like to make a donation online, please visit our foundation’s website at www.patientadvocate.org/donate.

Since the launch of the Co-Pay Relief program in 2004, we have adhered to a set of guiding principles that have created a secure, supportive and sustainable patient service. These principles remain our compass for the future evolution of the program.

Patient-Centric | Efficient | Comprehensive Supportive | Compassionate | Compliant

Program Compliance

As a pioneer in the field of co-payment support programs, we not only operate our program in compliance with the guidance provided by the Office of Inspector General (OIG), but we hold ourselves to the higher standard of keeping the needs of the patients we serve at the center of all programmatic decision making. Our program is one of the only fully OIG-compliant methods to support the prescription drug co-payment and insurance premium costs that are incurred by patients who are insured by government-sponsored plans including Medicare, Tricare and Medicaid.

CPR is an Office of Inspector General approved co-payment assistance program for insured Americans offered through Patient Advocate Foundation. PAF is a 501(c)(3) non-profit organization that provides professional case management services to Americans with chronic, life-threatening and debilitating illnesses.

Q.

Q.

Q.

Q.

Q.

A.

A.

A.

A.

A.

Scan for a

full list of FAQs

Toll Free: 1-800-532-5274 |www.patientadvocate.org

help@patientadvocate.org | Tax ID #54-1806317 Toll Free: 1-866-512-3861 | www.copays.org

Fax: 757-952-0119 | cpr@patientadvocate.org

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