Frequently Asked Questions

What are copay assistance programs?

• Copay assistance programs are offered by drug manufacturing companies as a direct way to lower out-of-pocket costs for drug costs for eligible patients. Copay assistance is financial assistance that helps all patients who have commercial insurance pay for medical out-of-pocket expenses (for example, copay, coinsurance and deductible). Generally, these programs do not have income limitations.
• What is the eligibility requirement for copay assistance programs?
  • You have commercial or private insurance.
  • Medicare or Medicaid does not qualify for copay assistance programs.
  • You are being treated with specific medicines as listed by the drug manufacturer.

What are grant programs?

• Programs that offer financial assistance to help patients pay for out-of-pocket expenses toward their specific disease. Grants help pay for medicine copay costs and health insurance premiums. The grant programs are independent programs that help underinsured people with life-threatening, chronic and rare diseases get the medicines and treatments they need. The programs assist with out-of- pocket costs and advocate for improved access and affordability.
• What are the eligibility requirements for grants?
  • You're getting treatment for the disease named in the disease fund.
  • Your prescribed medicine must be listed as a covered medicine for your disease fund.
  • You have health insurance that covers your qualifying medicine or product. Note: Health insurance requirements vary by fund.
  • Your income must fall at or below the federal poverty level specified by the disease fund.
• Patients need to have health insurance that covers their qualifying medicine or product. Patients must reside or receive treatment in the United States or U.S. territories. U.S citizenship may not be required as specified by disease fund.

Who funds these programs?

They seem too good to be true.

These programs receive funding from donors and pharmaceutical companies.

What is needed to qualify for copay assistance programs?

• You have commercial or private insurance.
• Medicare or Medicaid does not qualify for copay assistance programs.
• You are being treated with specific drugs as listed by the drug manufacturer.

If I have a commercial Medicare Advantage product, can I qualify for copay assistance programs?

• No. Copay assistance programs consider Medicare Advantage products, even when administered by a "commercial" carrier, to be government products. Therefore, you are not eligible.
• However, you might qualify for a grant.

If I have a commercial insurance primary and a Medicaid or Medicare product secondary, can I qualify for copay assistance programs?

No. Copay assistance programs require that you only have commercial insurance(s). You cannot have any government products to qualify. However, you might qualify for a grant.

What is needed to qualify for grants?

• You're getting treatment for the disease named in the disease fund.
• Your treatment must be listed as a covered service for your disease fund.
• You have health insurance that covers your qualifying medicine or product. Note: Health insurance requirements vary by fund.
• Your income must fall at or below the specified income level.
• You must reside and receive treatment in the United States or U.S. territories. Note: U.S. citizenship is not required.
• Note: Some grants are available to all insurance types, while some are limited to only Medicare insurance types.

What is the Release of Information (ROI) form?

• This form allows Mayo Clinic financial navigators to submit the initial program application, submit explanation of benefits and claim information to secure reimbursement, and apply any program payments specifically to the charges for which the payment was approved.
• The ROI form — the Mayo Clinic Authorization to Release Protected Health Information to a Third Party (PDF) — can be downloaded.
• Mayo Clinic financial navigators will fill out the program detail on your behalf to ensure that all required information is included. Once they send you the copy via portal message or DocuSign, please promptly fill in any remaining items and return the form.

Who can assist me with oral chemotherapy or retail pharmacy questions?

The pharmacy that is dispensing the over-the-counter medicine or oral chemotherapy can help you with any free medication or copay assistance programs. The pharmacy also might have drug manufacturer coupons you can use.

Who can assist me with travel or lodging?

Patient Navigation and Social Work staff members can assist you with other programs that would help cover travel or lodging needs.

Does my provider have to do anything?

• Your doctor will be asked to fill out a form (called a medical attestation) that validates the medicine and diagnosis related to your services.
• The Financial Navigator staff in partnership with the patient navigation and social work staff will assist you in this process or do it for you.