For consumers who can't afford to pay for medications, the struggle can be literally a matter of life or death.
The good news is, you don't have to go without your meds. Help is available through major drug companies' patient assistance programs.
These programs offer free or low-cost drugs to uninsured individuals who can't afford their medications. Most brand-name drugs are found in these programs.
Patient assistance programs have been a godsend for Dallas resident Hobert Haggerty's elderly parents, who live on a fixed income. Her father and mother each take several medications a day.
"I am so thankful for the program," she said. "It's helped because the medications are so expensive -- $300 or $400 for a 30-day supply gets expensive."
Each drug company has its own rules about who qualifies for its assistance program, but generally, you must be a U.S. citizen or legal resident, have no prescription drug coverage and meet certain income requirements.
"Generally, the income criteria will range from 200 percent of the federal poverty level to 400 percent of the federal poverty level, and there are instances where it could be higher," said Tracy Foster, president of Lash Group, which administers patient assistance programs for pharmaceutical firms.
For a one-person household, that's an income cap of $22,340 to $44,680. For a two-person household, incomes could be as high as $30,260 to $60,520, depending on the program's rules.
Recipients of Medicare's Part D prescription drug benefit aren't necessarily disqualified. In fact, most major drug companies have provisions for Medicare patients to qualify, Foster said.
"It is sometimes under a special program and may require a special application," she said. "It sometimes requires that a patient already have spent a certain amount of money under their Medicare Part D benefit to qualify."
Pfizer Inc. helps Medicare patients through "hardship exceptions," said Gary Pelletier, director and team leader for Pfizer Helpful Answers, a group of programs that help the uninsured and underinsured get access to the company's medicines for free or at a savings.
"They have to meet income eligibility criteria," he said. "When they qualify for a hardship exception, we will give them the medicine for free through the end of the calendar year. We provide that entirely outside of the Medicare Part D benefit."
The patient assistance programs can be of particular benefit to the millions of workers who have lost their jobs since the economic downturn.
Although it doesn't collect employment data, Merck said its patient assistance program has seen a 50 percent increase in enrollees over the past three years, said spokeswoman Kelley Dougherty.
And Pfizer launched its MAINTAIN (Medicines Assistance for Those who Are In Need) program for the unemployed in 2009 "in response to the economic crisis," Pelletier said.
"Many of the manufacturers have responded to increasing need by reassessing their income criteria," Foster said. That has helped more patients qualify for assistance.
"Over the last three to five years," she said, "we have seen manufacturers increase the [income] limit, so they're accepting patients at higher income levels and acknowledging that there are just greater financial hardships generally speaking, given the economy."
Here's what you need to know about these programs:
*Talk to your doctor: "Most of the applications for assistance need doctor participation," Foster said. "It will also require a prescription or doctor's signature saying the patient is actually being prescribed the medication they're seeking help for."
Make it as easy as possible for the doctor's office.
Fill out as much of the application as you can. Highlight the directions for the doctor and where he or she needs to sign. Give the doctor's office an addressed-and-stamped envelope to send in the application or highlight the fax number so it's easy to find.
"A lot of times, it's good to have a contact at the doctor's office," said Amy Zubrzycki, director of the Senior Prescription Assistance Program at the Senior Source, a Dallas-based nonprofit. "They can help speed up that information to the doctor, getting it signed and getting it back to you."
*Don't rush it: Most programs have income criteria, and you must provide proof of income. Foster said if you've lost your job, include an explanation in your application that says, "Here's my previous year's tax documentation, but I am currently unemployed."
Read the application instructions carefully and be sure you understand them and follow them precisely.
"What can slow down the process sometimes is there's missing information on the application or missing paperwork," Pelletier said.
Some programs are fussy about their applications, according to NeedyMeds, a nonprofit information source that helps people find patient assistance programs.
"The directions on the application should be completed exactly as directed," the organization said. "Print neatly. If something is unreadable or there is a blank, then the application may be denied, which can delay the process of receiving the medicine." Put "N/A' or "not applicable' in blanks that aren't filled out to indicate that the material was read through and not skipped over, NeedyMeds said.
*Plan ahead: Plan ahead so your medicine supply doesn't run out, NeedyMeds said.
"When sending in an application, pay attention to the refill process and the amount of allowable refills," the organization said. "Each program is different. Some may require a call from the doctor's office, while another may allow the patient to call directly for a refill. Others may require a new application, which takes time."
*Ask questions: Call the patient assistance program if you have any questions.
"Eligibility requirements, drugs, dosages, even programs change regularly, so it's best to go directly to the program for information," NeedyMeds said. "If you do not qualify for the program but cannot afford the medicine, then tell the representative. Some companies may make hardship exceptions and are willing to review situations on a case-by-case basis."
You can also ask your doctor to write an appeal letter explaining your financial hardship.
So don't let hard times force you to choose between paying for medications and other essentials for your survival. Take advantage of patient assistance programs.