Frequently Asked Questions

 

Frequently Asked Questions


PROGRAM TERMS AND CONDITIONS

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

PROGRAM DISCLAIMER

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

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 the patient's insurer for medications prescribed to treat and manage their disease.

2.   Q. Are your services free?
A. Yes, our services are completely free.

Application Related Questions

1.   Q. What are the eligibility criteria for the CPR program? 

A.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 of 400% of Federal Poverty Guidelines (FPG) or less, adjusted by the Cost of Living Index (COLI) for where you live (300% for the Osteoporosis silo)
  • Have active insurance coverage that includes coverage for pharmaceutical products

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 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.

3.   Q.How long does it take to know if I am eligible for assistance from the program?
A.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.

4.   Q.Do I have to submit any additional information to the program after I have been approved for assistance?
A.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.

  • Approved (N): Patient is approved for assistance and income has been verified. Income documentation is not required and eligible expenditures may be submitted immediately.
  • 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.
  • Pending-Income Verification: Patient's income is still pending verification. Please check back later to determine if additional documentation needs to be submitted.

5.   Q.How do I apply for assistance to the CPR program?
A.There are four easy ways to apply for assistance:
Your treating physician’s office can assist you with making the application for assistance via the provider portal available 24 hours a day at https://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 https://www.copays.org/pharmacy

You, or someone you designate to assist you, can make an application for assistance via the patient portal available 24 hours a day at https://www.copays.org/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.

6.   Q.Can I apply to your program by leaving a voicemail, sending an e-mail or by fax?
A. 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.

7.   Q.If approved into the program, how long before a patient can begin submitting eligible claims for payment?
A. 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.

8.   Q.What information is needed to use the Virtual Pharmacy Card?
A. 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 #

 

 Expenditure Related Questions

1.   Q.I have been approved to receive assistance from the program and have outstanding bills. Can you help me with those?
A.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.

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 products prescribed to treat and manage your disease. For detailed information, click here: Guide to Expenditure Payments.

3.   Q.Are there utilization requirements for my award?
A.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

4.   Q.I have been approved to receive support from 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.

5.   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 for assistance was approved prior to the date the patient passed away.

6.   Q.Is there a waiting list to get into your program?
A.Our program operates on a first-come, first-served basis as long as funding is available; therefore, we do not have a waiting list.

 

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 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..

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.What medications are covered by CPR?
A.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.


MEDICAL DIAGNOSIS RELATED QUESTIONS

1.   Q.Does CPR cover all services relative to my diagnosis?
A.No, medical services including, but not limited to, lab work, office visits, surgeries, radiation therapy and scans are not eligible expenses under the program.

2.   Q.Can I apply for assistance in more than one disease fund if I have multiple diagnoses?
A.You 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 have been in treatment in the past 6 months.

4.   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.

5.   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.