Medication Coverage

1. Getting treatment covered by insurance
2. Covering treatment for the uninsured
3. Patient Assistance Programs

Getting treatment covered by insurance

  • Find health insurance through the NY Marketplace here.
  • See the NYS Medicaid Pharmacy Benefit Information Website. Provides easy access for members and providers looking for information on the drugs and supplies covered by different Medicaid and Family Health Plus health care plans.
  • Specialty Pharmacies help patients and medical providers with ordering  medications, prior authorization, counseling patients about use, and providing treatment adherence support.
  • CoverMyMeds is a free web based service that helps physicians and pharmacists complete Prior Authorization and other insurance coverage determination forms for any drug and almost all drug plans.

Steps to take if treatment is denied by insurance

Community Health Advocates offers resources to assist providers and patients in filing appeals, fair hearings and grievance or complaints.
Give them a call to get started: 800-614-5400.

  1. Appeal: A treatment denial can be appealed. Medical providers and patients can contact the health insurance company using the phone number on the back of the membership card to file an appeal.
  2. Fair Hearing: If the treatment is still not approved after the appeal,  a Fair Hearing can be requested. A Fair Hearing is a chance for you to tell an administrative law judge why you think your health insurance should cover your treatment.
  3. A grievance or complaint should  be filed if a recommended medication is denied. Filing a grievance or complaint is the only way health insurance regulators will know there is a problem with patient care.
  4. Report it to the Health Care Bureau. The NYS Attorney General’s office requests that all patients, their doctors, or their representatives make a call to Health Care Bureau’s toll-free Helpline or fill out a complaint form if they feel they have been wrongly denied coverage for their Hep C treatment medications.

 

Covering treatment for the uninsured

See special programs and resources for the uninsured.

Patient Assistance Programs

Cover the cost of medications or co-pays

Pharmaceutical Patient Assistance Programs

Private Patient Assistance Programs

  • Prescription Assistance 360
  • Partnership for Prescription Assistance Programs
    Brings together America’s pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients without prescription drug coverage get free or low-cost medicines through the public or private program that’s right for them.
  • Patient Access Network (PAN)
    Independent non-profit organization that provides assistance to under-insured patients for their out-of-pocket expenses for life-saving medications. Has Hep B & Hep C assistance! You can view and distribute this brochure about PAN services for Hep B & C patients.
  • NeedyMeds
    Non-profit information resource devoted to helping people in need find assistance programs to help them afford their medications and costs related to health care.
  • NYCRx
    Non-profit organization working to increase access to affordable medications for medically underserved communities. Free Discount Prescription Card and list of partnering health centers with drug discount programs for their patients.
  • Chronic Disease Fund
    Non-profit charitable organization that helps people with chronic disease, cancer and other life-altering conditions obtain the life-savings medications they need. Disease states may open and close throughout the year as funds are diminished or become available.
  • RxAssist
    Comprehensive database of patient assistance programs, as well as news and practical tools.

 

 

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