When your prescription costs more than your grocery bill, you’re not alone. In 2023, prescription assistance programs helped over 12.7 million Americans pay for medications they couldn’t otherwise afford. These aren’t charity handouts - they’re structured programs run directly by drug makers like Pfizer, Merck, and Eli Lilly. And while they’re not perfect, they’re often the only thing standing between patients and skipped doses.
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 work in completely different ways.Copay assistance programs are for people who have insurance but still pay too much out of pocket. Think of them as coupons you use at the pharmacy. If your copay for a specialty drug is $200, the manufacturer might cover $180, leaving you to pay just $20. These cards are usually accepted at the counter - you just show your insurance and the card, and the discount is applied automatically. About 85% of specialty drugs now offer this kind of help, according to KFF’s 2023 report.
Patient Assistance Programs (PAPs) are for people without insurance or with very limited coverage. If you’re uninsured and your income is below 400% of the Federal Poverty Level (about $60,000 for a family of four in 2023), you might get your medication for free. Some PAPs even ship pills directly to your home. These programs have been around since the 1980s, originally created to help people with HIV/AIDS get life-saving drugs. Today, 92% of major pharmaceutical companies run at least one PAP.
Who Gets Help - And Who Doesn’t
Not everyone qualifies. And the rules are messy.Copay cards usually don’t work if you’re on Medicaid or Medicare. In fact, 78% of state Medicaid programs ban them entirely because they believe these cards push people toward more expensive brand-name drugs instead of cheaper generics. Medicare Part D has its own twist: even if you use a copay card, the money doesn’t count toward your out-of-pocket spending that gets you out of the coverage gap. That means you stay stuck in the "donut hole" longer.
PAPs have their own restrictions. About 62% of them won’t help if you have any kind of government insurance - not even Medicare Part D. So if you’re on Medicare but still can’t afford your meds, you’re caught in a gap. Some PAPs will help you if you’re uninsured, but not if you have private insurance - even if that insurance has a $10,000 deductible.
And if you’re on Medicare Part D and qualify for a PAP, the drug you get through the program won’t count toward your true out-of-pocket cost (TrOOP). That’s a big deal. It means you won’t reach catastrophic coverage any faster. You’ll keep paying high coinsurance for months - or years - longer than you should.
How Much Money Are We Talking About?
In 2022, drug companies gave away $24.5 billion in patient assistance. That’s more than the entire annual budget of some U.S. states. Most of that went to copay cards - not free drugs. The average copay program caps out at $10,000 to $25,000 per year per patient. Some have monthly limits: $50 to $200 per prescription. A few require you to pay a small monthly fee - like $10 - to keep using the card.For PAPs, the savings can be total. Take Dulera, a common asthma inhaler. One manufacturer’s PAP lets eligible patients pay as little as $15 per prescription, up to 12 times a year. That’s $180 a year instead of $1,200. Teva’s Cares program offers dozens of generic and brand-name drugs at no cost to qualifying U.S. residents.
But here’s the catch: these programs are not free for the companies. They’re a business decision. Manufacturers know that if they don’t offer help, patients won’t take their expensive drugs - and they’ll lose sales. So while they help people, they also protect their bottom line.
The Hidden Costs and Controversies
Critics say these programs make drug prices worse. A 2022 study in JAMA Internal Medicine found that copay assistance encouraged people to pick brand-name drugs over generics - even when the generic was just as effective. That pushed total drug spending up by $1.4 billion a year.Insurers hate it. Many now use "copay accumulator programs" - which means your manufacturer discount doesn’t count toward your deductible. So even if you’re using a $150 copay card, your deductible stays at $5,000. You’re still paying full price until you hit that number. As of 2023, 78% of major insurers use these programs.
States are stepping in. Twenty-two states have passed laws to limit or track copay assistance. California now requires drugmakers to report exactly how much they spend on these programs. In 2023, the Department of Health and Human Services proposed new rules demanding more transparency. The goal? To stop manufacturers from hiding behind "charity" while keeping prices artificially high.
How to Apply: It’s Not as Hard as You Think
The biggest problem? Most people don’t know these programs exist. A 2022 survey found only 37% of eligible patients were aware of any manufacturer assistance.Start with the Medicine Assistance Tool (MAT), run by PhRMA. It’s free, confidential, and lets you search over 900 programs by drug name, income, or insurance status. You don’t need to create an account. Just enter your drug and zip code, and it shows you what’s available.
For copay cards: Once you find a match, download or print the card. Bring it to your pharmacy with your prescription and insurance. The pharmacist will apply it at checkout.
For PAPs: You’ll need more paperwork. Most require:
- Proof of income (last two pay stubs or tax return)
- Proof of residency (utility bill, driver’s license)
- Doctor’s note confirming medical need
- Insurance status documentation
Applications can take 45 to 60 minutes to complete. Some programs require annual renewal. Others give you coverage as long as you stay eligible. Don’t get discouraged if you’re rejected - try another program. Some drugmakers have multiple PAPs for the same medication.
What If You’re Still Stuck?
If you’re uninsured, on Medicaid, or your drug isn’t covered by any PAP, you’re not out of options. Nonprofits like the Patient Advocate Foundation and NeedyMeds offer free help navigating these programs. Some local clinics and pharmacies have partnerships with drugmakers to provide samples or discounted meds.And if you’re on Medicare, ask your pharmacist about the Extra Help program (Low-Income Subsidy). It can cut your Part D costs by up to 75%. You can apply through Social Security.
Don’t assume you don’t qualify. Many patients think they make too much money - but 400% of the Federal Poverty Level is higher than most people realize. For a single person, that’s $55,560 in 2023. For a family of four, it’s $114,000. If you’re struggling to pay, you might be eligible.
The Bigger Picture
These programs are a bandage on a broken system. They help millions - but they don’t fix why drugs cost so much in the first place. The NIH says no one tracks how many people actually get help, or whether these programs reduce hospital visits or improve health outcomes. We know how much money is spent - but not whether it’s making people healthier.That’s why experts are divided. Some say these programs are essential lifelines. Others say they let drug companies off the hook. The truth? For now, they’re the best tool we have. And if you’re paying too much for your meds, you owe it to yourself to look into them.
Can I use manufacturer copay assistance if I have Medicare?
Yes, you can use copay assistance cards with Medicare Part D - but the money won’t count toward your out-of-pocket spending that gets you out of the coverage gap (donut hole). The drugmaker pays the difference, but Medicare treats it as if you paid nothing. That means you stay in the gap longer and pay more over time.
Do I need to be a U.S. citizen to qualify for a Patient Assistance Program?
No, you don’t need to be a U.S. citizen. Most PAPs require proof of legal residency in the United States, not citizenship. You’ll need to show a U.S. address and valid ID - like a driver’s license or state ID - but your immigration status doesn’t automatically disqualify you.
Are generic drugs covered by manufacturer assistance programs?
Rarely. Most copay cards and PAPs are only for brand-name drugs - especially specialty medications that cost over $500 a month. Generic drugs are already low-cost, so manufacturers rarely offer discounts on them. But some companies, like Teva, do have PAPs that include select generics - check the Medicine Assistance Tool for specifics.
What if my doctor won’t help me apply for a PAP?
You don’t need your doctor to fill out the entire application. Most programs just need a signed form confirming your diagnosis and medical need. If your doctor refuses, call the program directly - many have patient navigators who can help you get the paperwork done. Some even provide pre-filled forms you can take to your provider for a quick signature.
How long does it take to get approved for a PAP?
Approval usually takes 2 to 4 weeks. Some programs offer expedited processing for urgent cases - like cancer or life-threatening conditions - and can approve you in under 72 hours. Always ask about emergency options when you apply.
Can I use more than one manufacturer assistance program at the same time?
Yes, if you take multiple medications from different manufacturers, you can use a copay card for each. You can also apply for separate PAPs for each drug. Just make sure you meet the income and insurance requirements for each program individually. Don’t assume one approval means you’re approved for others.
