How to Register for Patient Assistance
Each patient assistance program is a bit different, but generally you will be asked to fill out an application and supply information about where you live, what you earn, and who and how old you and other family members are. In the case of patient assistance for medications you will be asked for the name and dose of the medication and will probably need to submit a valid prescription from your doctor or nurse practitioner. Hospitals and clinics may require detailed medical records. Many hospitals and clinics have social workers on staff to assist you with your application.Things You'll Need
- Patient assistance application
- Prior year tax return
- Current pay stubs
- Profit and loss statement
- Statement of retirement benefits
- Disability award letter
- Bank account balances and statements
- Proof of identity and birthdate
- Proof of address or homeless shelter residency statement
- Medical insurance coverage
- Medical records
- Written prescriptions
Instructions
File the Application and All Supporting Documentation
Obtain the proper application form from your hospital, clinic or the pharmaceutical company that manufactures the drug you are taking. You can ask your doctors or social workers for their institution's forms or download them from the Internet. Most pharmaceutical company prescription assistance forms are online as well or you can call or write to request them.
Fill out the patient assistance application form as completely and accurately as you can. Incomplete applications will be returned to you or rejected. Ask for assistance from social workers at your clinic, hospital or human services office if needed. There also are free and fee-for-service online assistance filing organizations. The application will ask for basic information about your age, where you live, your income, size of your household and living expenses.
Make copies of all the requested supporting financial information. Usually you will be asked to submit your tax return for the prior year and proof of income for the current year. If you are employed you will probably need your most recent pay stubs. If self-employed you will need to submit a profit and loss statement showing your income and expenses. You will be asked for a copy of your award letter if you are disabled and for statements of retirement income if you are retired. Many patient assistance programs will want to know the balances and have a copy of at least one recent bank statement for any accounts you have as well.
Copy and submit proof of identity and age, and residency documents as requested. Usually you can submit any form of ID that shows your birthdate and those of your household members. Copies of social security cards may be required. You may be asked for a piece of canceled mail if your current address is not reflected on your ID. Some US programs for medical and prescription assistance will need to confirm US citizenship or legal residency.
Gather and copy all pertinent medical, medical insurance, and prescription information and submit it with the application. Prescription assistance programs that deliver medication to you through your care provider will need a copy of the written script in order to fill the medication order.