When you’re prescribed a life-changing medication-say, for diabetes, asthma, or rheumatoid arthritis-and the price at the pharmacy is $800 a month, it’s not just expensive. It’s impossible. That’s where prescription assistance programs come in. These are direct support systems run by drug manufacturers themselves, not insurance companies or government agencies. They exist to keep people on their meds when the cost would otherwise force them to skip doses, split pills, or go without.
There are two main types: copay assistance programs and Patient Assistance Programs (PAPs). They sound similar, but they serve completely different groups of people and work in totally different ways.
Copay Assistance: For the Insured Who Still Can’t Afford It
Copay assistance programs are for people who have insurance but still get hit with high out-of-pocket costs. Think of it like a discount card you get directly from the drugmaker. When you show it at the pharmacy, the manufacturer pays part-or all-of your copay or coinsurance. You might walk out paying $10 instead of $200.
These programs are mostly for brand-name drugs, especially specialty medications. According to PhRMA’s 2023 report, 68% of all copay assistance programs are tied to specialty drugs like those for multiple sclerosis, cancer, or rare autoimmune conditions. These are drugs with no cheap generics, and they often cost over $1,000 per month.
But there are limits. About 45% of these programs cap the total amount they’ll pay in a year-sometimes as low as $1,000, sometimes up to $25,000. Monthly limits are also common. For example, a program might cover up to $150 per month. If your drug costs $500 and your copay is $400, you’re still on the hook for $250 after the assistance.
Some programs even require you to pay a small fee-like $10 per prescription-as a way to show commitment. The Asthma and Allergy Foundation of America notes this is common with inhalers like Dulera. If you qualify, you might pay as little as $15 per prescription, with a maximum savings of $90 per fill.
Patient Assistance Programs (PAPs): For Those Without Insurance
PAPs are the lifeline for people without insurance-or with insurance that doesn’t cover their drug. These programs give medications for free or at a deeply reduced price, often under $10 per month. Eligibility is based on income. Most require you to earn less than 400% of the Federal Poverty Level. In 2023, that meant a family of four making under $60,000 a year.
PAPs aren’t new. They started in the 1980s during the HIV/AIDS crisis when drug companies began giving away antivirals to those who couldn’t pay. Today, 92% of major pharmaceutical manufacturers run at least one PAP. In 2022 alone, these programs gave out $24.5 billion in assistance, helping 12.7 million people, according to PhRMA.
But getting into a PAP isn’t easy. You need proof of income-tax returns, pay stubs, or government benefit letters. You need to prove you’re a U.S. resident. You need a doctor to fill out paperwork confirming the drug is medically necessary. The average application takes 45 to 60 minutes. And if you’re on Medicaid or Medicare, many PAPs won’t touch you. CMS guidelines from January 2024 show that 62% of PAPs exclude patients with government insurance.
The Big Catch: What Insurance Plans Don’t Tell You
Here’s the hidden problem: even if you have copay assistance, your insurance plan might not let it count toward your deductible.
More than 78% of major insurers now use something called a “copay accumulator.” That means the money the manufacturer pays doesn’t get added to your out-of-pocket total. So even if you’ve paid $5,000 in copays thanks to coupons, your insurance still sees you as having paid $0. That keeps you stuck in the coverage gap longer-especially bad for Medicare Part D users.
And here’s another twist: PAP assistance doesn’t count toward your Medicare Part D true-out-of-pocket cost (TrOOP). That’s the number that determines when you hit catastrophic coverage. So if you’re on Medicare and getting free drugs through a PAP, you’re not moving closer to the point where your costs drop dramatically. You’re stuck paying full price forever, even though you’re not paying anything.
Some states are pushing back. As of January 2024, 22 states have passed laws to limit or ban manufacturer copay assistance. California’s SB 1424, which took effect in 2024, forces drugmakers to publicly report how much they spend on these programs. Why? Because critics say these programs push people toward expensive brand-name drugs instead of cheaper generics-even when the generic is just as effective.
How to Find and Apply
You don’t have to guess which program might help you. The Medicine Assistance Tool (MAT), run by PhRMA, is a free, confidential search engine that lists over 900 assistance programs from more than 200 manufacturers. Just enter your drug name, insurance status, and income level. It tells you exactly which programs you qualify for.
For copay cards: Once you find a match, download the card, print it, and bring it to the pharmacy. The pharmacist swipes it like a credit card, and the discount is applied automatically. No paperwork. No waiting.
For PAPs: You’ll need to fill out an application-usually online. Some programs let your doctor’s office submit it for you. Others require you to mail documents. Keep copies of everything. If you’re denied, ask why. Many times, it’s just a missing signature or an outdated tax form.
Don’t assume you’re not eligible just because you have insurance. Some PAPs help people with high-deductible plans if their out-of-pocket costs exceed a certain percentage of their income. Always check.
Who Gets Left Out?
Despite all this help, millions still fall through the cracks. In 2023, 28 million Americans had no health insurance at all, according to the Census Bureau. Many of them can’t afford even $10-a-month medications. And while PAPs exist, they’re not guaranteed. Some programs run out of funds mid-year. Others only cover one drug, not the full cocktail a patient needs.
Even if you qualify, awareness is low. A 2022 survey by the Patient Advocate Foundation found only 37% of eligible patients knew about manufacturer assistance programs. That means two out of three people are paying full price because they never heard these programs existed.
Is This the Real Solution?
Let’s be honest: these programs are a band-aid. They help people today, but they don’t fix why drugs cost so much in the first place. Critics argue they let manufacturers keep prices sky-high because they know they can offset them with coupons. A 2022 JAMA Internal Medicine study estimated copay assistance increased total drug spending by $1.4 billion a year by steering people away from cheaper alternatives.
But for someone choosing between insulin and groceries, or an inhaler and rent, this isn’t about systemic reform. It’s about survival. The fact that 12.7 million people got help last year shows how essential these programs are.
Right now, the system is broken. But if you’re struggling to pay for your meds, you don’t have to wait for Congress to fix it. The help is already here-waiting for you to ask for it.
Can I use copay assistance if I have Medicare?
Yes, you can use copay assistance if you have Medicare, but it won’t count toward your true-out-of-pocket costs (TrOOP) that lead to catastrophic coverage. The manufacturer’s payment is treated as separate from your Medicare Part D benefits. This means you may stay in the coverage gap longer, even if you’re paying less each month. Always check with your plan and the drugmaker’s program for details.
Do I need to reapply every year for a Patient Assistance Program?
It depends on the program. Some require annual re-enrollment, meaning you must submit updated income documents each year. Others offer continuous coverage as long as you remain eligible and refill your prescription. Always ask when you apply-this is one of the most common points of confusion.
Can I use both a copay card and a PAP for the same drug?
No. You cannot use both simultaneously for the same medication. If you qualify for a PAP (which gives you the drug for free or nearly free), you won’t need a copay card. If you have insurance and are using a copay card, you’re not eligible for a PAP. Programs are designed to be mutually exclusive to avoid double-dipping.
Are there programs for people who make too much for Medicaid but still can’t afford their drugs?
Yes. Many PAPs have income limits up to 400% of the Federal Poverty Level, which for a family of four in 2023 was $60,000. That means if you earn $55,000 and have no insurance, you may still qualify. Some programs also consider medical expenses when calculating eligibility. Always apply-even if you think you make too much.
Why won’t my Medicaid or Medicare cover the copay assistance card?
Most Medicaid programs prohibit the use of manufacturer copay assistance because they believe it drives up drug prices by encouraging brand-name use over cheaper generics. Medicare doesn’t block it, but it doesn’t count the assistance toward your out-of-pocket total. This is a policy decision, not a technical limitation. The goal is to prevent inflated pricing, but it leaves many patients confused and struggling.
Alex Ogle
February 7, 2026 AT 18:06Look, I’ve been on insulin for 12 years. I know what it’s like to stare at a $900 co-pay and wonder if your kid’s birthday party is more important than your next dose. These programs? They’re not perfect. But they’re the difference between life and a hospital bed. I’ve used PAPs when I lost my job, and copay cards when I got insurance but still couldn’t afford the deductible. No one’s handing out free money-but they’re handing out free medicine. And that’s something.
It’s not a fix. It’s a lifeline. And honestly? I’d rather have a lifeline that’s frayed than none at all.