Frequently Asked Questions
Frequently Asked Questions
General Questions About the Program
1. Q. What does the Patient Advocate Foundation's Co-Pay Relief Program (CPR) assist with?
A. CPR provides direct financial assistance with co-payments, co-insurance and deductibles required by your insurer for pharmaceutical treatments and/or prescription medications relative to your diagnosis.
2. Q. Are your services free?
A. Yes, our services are completely free.
Insurance Related Questions
1. Q. I do not have health insurance. Do I qualify for assistance through your program?
A.All applicants are required to have current health insurance or have had such coverage in the past 6 months to be eligible for assistance.
2. Q.I have health insurance but it does not cover my treatment and/or medications. Can CPR help?
A.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.
3. Q.Does CPR assist patients through the Medicare Part D coverage gap?
A.Yes, all payments that are made on your behalf for pharmaceutical treatments and/or prescription medications 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.
4. Q.I have a Medicaid “Share of Cost” or “Spend Down”. Does the CPR program assist with this?
A.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.
5. Q.Does CPR provide assistance with insurance premiums?
A.No, CPR does not provide assistance with insurance premiums at this time.
6. Q.Does the CPR program have income guidelines?
A.Yes, we take into consideration number in household, Cost of Living Index (COLI) in your area, and your household income must fall below 500% of the Federal Poverty Guideline (FPG).
7. Q.What medications does your program cover?
A.Our program is not drug specific. We assist with co-payments, co-insurance, and deductibles for both curative and supportive pharmaceutical treatments and/or prescription medications relative to your diagnosis as long as the products are covered by your insurance policy.
Medical Diagnosis Related Questions
1. Q.Does CPR cover all services relative to my diagnosis?
A.No, medical services such as lab work, office visits, surgeries, radiation therapy and scans are not covered by the program.
2. Q.Can I apply for assistance in more than one disease fund if I have multiple diagnoses?
A.No, patients can only apply for assistance in one disease fund per award year.
3. Q.I have been diagnosed with a qualifying disease, but I haven't begun treatment. Do I qualify for your program?
A.All applicants are required to be currently in treatment, planning to begin treatment in the next 60 days or has been in treatment in the past 6 months.
Application Related Questions
1. Q.Can I apply to your program by leaving a voicemail, sending an e-mail or by fax?
A.No, our program accepts applications via phone or through the online application accessible on our website. Leaving a voice mail, sending an email request and/or faxing an application request are not acceptable methods to initiate an application.
2. Q.Can anyone, other than the patient, apply to the program?
A.Yes, anyone can apply to the program on the patient's behalf; however, the application must ultimately be signed by the patient, his/her legal guardian, or a Power of Attorney.
3. Q.The patient has passed away. Can CPR help with his or her outstanding medical bills?
A.CPR can assist the patient provided the application is signed by the patient, his/her legal guardian, or a Power of Attorney prior to the patient passing away.
4. Q.How do I apply for assistance to the CPR program?
A.There are four easy ways to apply for assistance:
- Your treating physician can assist you with making the application for assistance via the provider portal available 24 hours a day at http://www.copays.org/providers
- Your pharmacy that is dispensing your prescribed medications can assist you with making the application for assistance via the pharmacy portal available 24 hours a day at http://www.copays.org/pharmacy
- You can make an application for assistance via the patient portal available 24 hours a day at http://www.copays.org/patients
- Toll free at 866-512-3861, option 1, to be connected directly to a CPR representative
5. Q.If approved into the program, is the patient's grant guaranteed?
A.Approved patients will receive a guaranteed allocation of 33% of the total annual award amount with the remaining balance being accessible on a first come first serve basis based on fund availability.
6. Q.If approved into the program, how long before a patient can begin submitting outstanding bills for payment?
A.Approved patients within CPR, their treating physicians, and/or the pharmacies dispensing their prescribed medication(s) are eligible to begin submitting expenditures immediately! However, please note if there are no processed expenditures for a period of 120 days, a patient's annual award will be rescinded, the account will be closed, and the patient will not be eligible to re-apply until the award year expires.
Expenditure Related Questions
1. Q.I have just been approved into the program and have outstanding bills. Can you help me with those?
A.Yes, the CPR program offers up to a 6 month "look back period" that begins on the date you are approved for assistance through the program. You, your treating physician, and/or the pharmacy that is dispensing your prescribed medications can submit outstanding bills for pharmaceutical treatments and/or prescription medications that are associated with the treatment of your diagnosis.
2. Q.Who will the CPR program make payments to on my behalf?
A.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 treatments and/or prescription medications. For detailed information, click here:
Guide To Expenditure Payments
3. Q.I have been approved to the program and have exhausted my award. Can I apply again for additional assistance?
A.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.
4. Q.Is there a waiting list to get into your program?
A.Our program operates on a first-come, first-served basis; therefore, we do not have a waiting list.
5. Q.Is PAF approved by the Office of Inspector General to operate the Co-Pay Relief Program?
A.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.
6. Q.I would love to donate to your program. What do I need to do?
A.First, PAF would like to say, “Thank you!” If you would like to make a one-time donation online, please visit our foundation’s website at www.patientadvocate.org and click on "Donate". – OR- Mail your donation to our corporate office at 421 Butler Farm Road, Hampton, Virginia 23666. Please make checks payable to Patient Advocate Foundation. For more information, you may contact PAF at 1-800-532-5274.