Consistent access to prescribed medication is essential for many people struggling with severe mental health conditions. However, in the US, the high cost of prescription medication and health insurance can make it difficult to afford pharmacotherapy treatment.
Fortunately, multiple federal, state, and private programs exist to help reduce the cost of prescription drugs for those who struggle to afford the medication they need.
Federal and state programs
- Federally Qualified Health Centers (FQHCs) offer care with sliding-scale fees based on income. To be eligible, you need to be uninsured or underinsured, have limited financial resources, and be a resident of the local service area that the FQHC serves. These organizations usually provide low-cost psychiatric medication as well as help with applying to other financial assistance programs. You can find a health center in your area on the Health Resources and Services Administration (HRSA) website.
- State Medicaid programs provide coverage for low-income individuals, including children, adults, seniors, and people with disabilities. Eligibility is usually determined by comparing your income to the federal poverty level, while also considering your household size and some additional state-specific criteria. To check the criteria that apply in your state, you can contact your state health department, or visit Medicaid’s state assistance map.
- The Medicare “Extra Help” Program is a federal scheme that helps people who are Medicare beneficiaries with limited income and resources, which can reduce the cost of mental health prescriptions under the Medicare drug coverage provisions. You can apply to Medicare Extra Help by contacting your local State Health Insurance program (SHIP) or online by visiting the Social Security Administration application page.
Independent Charitable Patient Assistance Programs (ICPAPs)
ICPAPs are nonprofit organizations that help cover the cost of medication-related co-payments, deductibles, or premiums, meaning they can help cover part or all of your insurance costs.
- The Patient Advocate Foundation offers co-pay assistance to individuals with chronic mental health conditions. Eligibility usually requires a diagnosis of a mental health condition and meeting certain income guidelines.
- The HealthWell Foundation provides funding for medication co-payments or insurance premiums for a broad list of illnesses, including mental health conditions, when funding is available. Eligibility is based on your income and having a confirmed diagnosis, but unlike some other programs, this one requires health insurance. You can check their website for a list of medications that they cover.
- The PAN Foundation (Patient Access Network) helps individuals who have insurance coverage and are actively receiving treatment. When it comes to income requirements, you normally have to be earning less than 500% of the Federal Poverty Level. You can visit their Find a Disease Fund page to check if you might be eligible.
- The Assistance Fund (TAF) supports patients with high medication costs, including mental health conditions, by covering co-pays, coinsurance, and sometimes premiums for specific medications. You can check eligibility on their website.
Pharmaceutical patient assistance programs (PAPs)
Several pharmaceutical manufacturers have programs to help eligible patients access mental health medication, known as patient assistance programs.
- Pfizer RxPathways is Pfizer’s PAP, which is now reserved for people who remain unable to afford their medication even after exploring all other options and programs. Before Pfizer’s PAP will consider an application for a covered Pfizer drug, you must enroll in the Medicare Prescription Payment Plan (MPPP), provide denial letters from all applicable ICPAPs, and meet the income cap of less than 300% of the Federal Poverty Level. A valid prescription is also required.
- Lilly Cares Foundation (Eli Lilly and Company) is a nonprofit charitable organization providing free access to Lilly medications for up to 12 months to eligible individuals. Prescribed medications for bipolar disorder, schizophrenia, and depression are included. You can check out the full list of available medications and eligibility criteria on their website.
- The Janssen Patient Assistance Program (Johnson and Johnson) helps people who are uninsured or have inadequate insurance coverage access certain drugs for free, though there are also some income requirements, and help is also limited to a maximum of 12 months. Medications covered under this program include certain antipsychotics such as Invega Sustenna, as well as other drugs. You can find eligibility requirements as well as links for online enrollment here.
- The AbbVie Patient Assistance Program provides access to some psychiatric medications for eligible low-income individuals. You can check their Patient Assistance page for more information on eligibility and applicable medications.
Discount programs, community organizations, and co-pay assistance
The Patient Advocate Foundation offers co-pay assistance to individuals with chronic mental health conditions. Eligibility usually includes a diagnosis of a mental health condition and meeting certain income limits.
Another way you can get significant discounts on prescription drugs is through pharmacy discounts, or by combining PAP with a pharmacy discount card. Many large pharmacies such as Walmart, CVS, and Walgreens offer discount cards or generic medication programs, which usually don’t require insurance, and are available to everyone.
Local community mental health centers often provide access to subsidized pharmacies and guidance on applying for federal, state, or private assistance programs.
Working with your healthcare provider
Talking openly with your prescriber about financial barriers can help you find different solutions to access the medication you need. Clinicians are often familiar with available resources and programs and may be able to refer you to the best one(s) for your specific medication(s).
They can also offer practical solutions such as switching to more affordable alternative drugs, providing you with letters of medical necessity, or helping you obtain prior authorization from insurers.
Practical steps to access low-cost medication
It helps to be prepared when working with medication assistance programs.
You can start by gathering the necessary documentation that these schemes generally require (such as your proof of income, insurance status, and prescriptions). Most programs have their own eligibility requirements, which makes things difficult, but there are certain things that each of them normally requires when you apply.
Research multiple potential PAPs, and ask your healthcare provider to help you navigate applications. Finally, keeping track of your medication supply and upcoming refill dates can prevent disruptions to your treatment while applications are being processed.
Further resources
- NeedyMeds offers an up-to-date database of available PAPs, including eligibility criteria and clear instructions on the application process.
- RxAssist provides detailed information on free or low-cost medications, as well as different Patient Assistance Programs.
- The Partnership for Prescription Assistance (PPA) connects patients with hundreds of programs based on their income, insurance status, and prescribed medications.
