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Prescription Financial Assistance

Health Insurance Terms

Paying for Medications Without Insurance

Paying for Medications When You Have Insurance

  • Information you can share with your doctor including template appeal letters.Drug discount cards and discount pharmacies offer discounts on some medicines. In some cases, drug discount cards can help to lower out of pocket costs at the pharmacy. They may be helpful for some symptom management medications or generic forms of some MS disease-modifying therapies. Examples include lower cost dalfampridine (generic Ampyra) and dimethyl fumarate (generic Tecfidera) through programs such as GoodRx and Cost Plus Drug Company. The National MS Society does not recommend any specific drug discount services in large part because each individual we speak to has unique needs.To learn about drug discount cards or discount pharmacies that may help lower your costs, ask your trusted healthcare providers and pharmacists for their advice. Needymeds offers details about a number of drug discounts and RxAssist has a list of questions to ask to help you find a card or discount pharmacy that will work for you.Ask your Medicare Part D or Medicare Advantage Plan how to submit receipts for medications you purchased using a drug discount program so that your payment may count towards your annual out of pocket spending." c-nmssatomrichtext_nmssatomrichtext-host="">
    If your medication isn’t covered under your health insurance, or the generic is covered but you prefer the brand name, work with your healthcare provider to file an appeal. In the appeal, ask the plan to cover the drug based on your unique health needs.
    • MS Navigator Tip: As more generics for disease-modifying therapies are introduced to the market each year, it’s not always possible to win an appeal for coverage of your preferred product, especially without evidence from your medical history to support your appeal.
    Information you can share with your doctor including template appeal letters.Drug discount cards and discount pharmacies offer discounts on some medicines. In some cases, drug discount cards can help to lower out of pocket costs at the pharmacy. They may be helpful for some symptom management medications or generic forms of some MS disease-modifying therapies. Examples include lower cost dalfampridine (generic Ampyra) and dimethyl fumarate (generic Tecfidera) through programs such as GoodRx and Cost Plus Drug Company. The National MS Society does not recommend any specific drug discount services in large part because each individual we speak to has unique needs.To learn about drug discount cards or discount pharmacies that may help lower your costs, ask your trusted healthcare providers and pharmacists for their advice. Needymeds offers details about a number of drug discounts and RxAssist has a list of questions to ask to help you find a card or discount pharmacy that will work for you.Ask your Medicare Part D or Medicare Advantage Plan how to submit receipts for medications you purchased using a drug discount program so that your payment may count towards your annual out of pocket spending.

  • See an overview of cost-savings programs that might provide assistance with prescription drug costs if you are eligible.
Medicaid (also called Medical Assistance): If you have limited income (under about $1,000 per month if you’re single) and limited assets you should apply for Medicaid in the state where you live. Medicaid will pay participating doctors, pharmacists, hospitals, or other providers for your care. Find Medicaid’s contact information here.
  • MS Navigator Tip: If you’re low income but not eligible for Medicaid, ask if your state offers a “spend down” or “medically needy” program that can help you get Medicaid benefits.
The Low Income Subsidy, or “Extra Help” program: If you have limited income (around $1,580/month if you’re single or about $2,130/month if you’re married) and assets, this program may assist with Part D (prescription) costs including monthly premiums, annual deductibles and copays. Information is available on the Social Security Administration's website. The application is available online or you can call 1-800-772-1213 to apply over the phone.State Pharmaceutical Assistance Program (SPAP): Some states fund SPAPs to help residents pay for prescription drugs. Some programs serve specific populations based on age, disability status and/or a specific diagnosis. Find out if SPAP is available in your state.Nonprofit Funding: There are several nonprofits that help with Medicare prescription costs for the MS disease-modifying therapies. Their assistance will count toward your out-of-pocket costs to get you through the donut hole more quickly.
  • HealthWell Foundation - 1-800-675-8416
  • Patient Access Network - 1-866-316-7263
  • The Assistance Fund - 1-877-245-4412
  • Good Days Fund - 1-877-968-7233
  • Patient Advocate Foundation Co-pay Relief Program - 1-866-512-3861

  • MS Navigator Tip: If these programs don’t have funds when you call, you are encouraged to check back as often as possible (daily, if that is an option) to see if their funding status has changed.
  • MS Navigator Tip: The Patient Access Network offers a FundFinder notification service for people in need of funding for MS therapies and premium assistance. Once a free account has been created, validated and the Multiple Sclerosis programs selected, users will receive updates when a program receives new funding. Register here.
Drug discount cards and discount pharmacies: Drug discount cards offer lower out of pocket costs at the pharmacy for some symptom management medications and some generic forms MS disease-modifying therapies. Examples include lower cost dalfampridine (generic Ampyra) and dimethyl fumarate (generic Tecfidera) through programs such as GoodRx and Cost Plus Drug Company. The National MS Society does not recommend any specific drug discount services in large part because each individual we speak to has unique needs.To learn about drug discount cards or discount pharmacies that may help lower your costs, ask your trusted healthcare providers and pharmacists for their advice. Needymeds offers details about a number of drug discounts and RxAssist has a list of questions to ask to help you find a card or discount pharmacy that will work for you.Ask your Medicare Part D or Medicare Advantage Plan how to submit receipts for medications you purchased using a drug discount program so that your payment may count towards your annual out of pocket spending.Pharmaceutical Assistance Programs: When all other resources have been exhausted, contact your drug manufacturer's Patient Assistance Program to request help with making your medication affordable. Realize, though, that pharmaceutical company funding is not always available for Medicare recipients and any assistance they provide will not count towards your out-of-pocket costs. When you call, explain that you cannot afford the copay for your treatment and that without the assistance program’s help you will not be able to adhere to your treatment." c-nmssatomrichtext_nmssatomrichtext-host="">
There may be resources that can help you lower your costs for disease-modifying therapies.
  • MS Navigator Tip: These programs are listed in order of highest value assistance to lower value assistance. Take care to review each one and to apply if you may be eligible.
  • See an overview of cost-savings programs that might provide assistance with prescription drug costs if you are eligible.
Medicaid (also called Medical Assistance): If you have limited income (under about $1,000 per month if you’re single) and limited assets you should apply for Medicaid in the state where you live. Medicaid will pay participating doctors, pharmacists, hospitals, or other providers for your care. Find Medicaid’s contact information here.
  • MS Navigator Tip: If you’re low income but not eligible for Medicaid, ask if your state offers a “spend down” or “medically needy” program that can help you get Medicaid benefits.
The Low Income Subsidy, or “Extra Help” program: If you have limited income (around $1,580/month if you’re single or about $2,130/month if you’re married) and assets, this program may assist with Part D (prescription) costs including monthly premiums, annual deductibles and copays. Information is available on the Social Security Administration's website. The application is available online or you can call 1-800-772-1213 to apply over the phone.State Pharmaceutical Assistance Program (SPAP): Some states fund SPAPs to help residents pay for prescription drugs. Some programs serve specific populations based on age, disability status and/or a specific diagnosis. Find out if SPAP is available in your state.Nonprofit Funding: There are several nonprofits that help with Medicare prescription costs for the MS disease-modifying therapies. Their assistance will count toward your out-of-pocket costs to get you through the donut hole more quickly.
  • HealthWell Foundation - 1-800-675-8416
  • Patient Access Network - 1-866-316-7263
  • The Assistance Fund - 1-877-245-4412
  • Good Days Fund - 1-877-968-7233
  • Patient Advocate Foundation Co-pay Relief Program - 1-866-512-3861

  • MS Navigator Tip: If these programs don’t have funds when you call, you are encouraged to check back as often as possible (daily, if that is an option) to see if their funding status has changed.
  • MS Navigator Tip: The Patient Access Network offers a FundFinder notification service for people in need of funding for MS therapies and premium assistance. Once a free account has been created, validated and the Multiple Sclerosis programs selected, users will receive updates when a program receives new funding. Register here.
Drug discount cards and discount pharmacies: Drug discount cards offer lower out of pocket costs at the pharmacy for some symptom management medications and some generic forms MS disease-modifying therapies. Examples include lower cost dalfampridine (generic Ampyra) and dimethyl fumarate (generic Tecfidera) through programs such as GoodRx and Cost Plus Drug Company. The National MS Society does not recommend any specific drug discount services in large part because each individual we speak to has unique needs.To learn about drug discount cards or discount pharmacies that may help lower your costs, ask your trusted healthcare providers and pharmacists for their advice. Needymeds offers details about a number of drug discounts and RxAssist has a list of questions to ask to help you find a card or discount pharmacy that will work for you.Ask your Medicare Part D or Medicare Advantage Plan how to submit receipts for medications you purchased using a drug discount program so that your payment may count towards your annual out of pocket spending.Pharmaceutical Assistance Programs: When all other resources have been exhausted, contact your drug manufacturer's Patient Assistance Program to request help with making your medication affordable. Realize, though, that pharmaceutical company funding is not always available for Medicare recipients and any assistance they provide will not count towards your out-of-pocket costs. When you call, explain that you cannot afford the copay for your treatment and that without the assistance program’s help you will not be able to adhere to your treatment.

  • Medicare, there may be resources that can help lower your costs for infusion disease-modifying therapies. Remember that these are generally billed twice, once for the cost of the drug and once for the cost of the administration.Medicaid (also called Medical Assistance): If you have limited income (under about $1,000 per month if you’re single) and limited assets you should apply for Medicaid in the state where you live. Medicaid will pay participating doctors, pharmacists, hospitals, or other providers for your care. Find Medicaid’s contact information.
    • MS Navigator Tip: If you’re low income but not eligible for Medicaid, ask if your state offers a “spend down” or “medically needy” program that can help you get Medicaid benefits.
    Medicare Savings Program (MSP): Also available through Medicaid, MSP may help with Medicare A and/or B costs, although eligibility is limited to individuals who have low income (around $1,350/month for an individual or $1,800/month if you’re married) and limited assets. Learn more about eligibility guidelines in your state, and contact Medicaid if you wish to apply.Nonprofit Funding: There are several nonprofits that help with Medicare prescription costs for the MS disease-modifying therapies. Their assistance will count toward your out-of-pocket costs to get you through the donut hole more quickly.
    • MS Navigator Tip: If these programs don’t have funds when you call, you are encouraged to check back as often as possible (daily, if that is an option) to see if their funding status has changed.
    • MS Navigator Tip: The Patient Access Network offers a FundFinder notification service for people in need of funding for MS therapies and premium assistance. Once a free account has been created, validated and the Multiple Sclerosis programs selected, users will receive updates when a program receives new funding. Register here.
    Pharmaceutical Assistance Programs: When all other resources have been exhausted, contact your drug manufacturer's Patient Assistance Program to request help with making your medication affordable. Tell them that you cannot adhere to your treatment without assistance. Realize, though, that pharmaceutical company funding is not always available for Medicare recipients and any assistance they provide will not count towards your out-of-pocket costs. When you call, explain that you cannot afford the cost of your treatment and that without the assistance program’s help you will not be able to adhere to your treatment.Help with the cost of infusion administration: If you need help specifically with the costs of administering your infusion medication, the following resources might also help:Some people with high healthcare costs may benefit from looking into other ways to get their Medicare. Programs such as Medicare Advantage Plans or Medigap can limit annual spending. MS Navigators are happy to discuss your coverage options. Contact an MS Navigator." c-nmssatomrichtext_nmssatomrichtext-host="">
    If you have Medicare, there may be resources that can help lower your costs for infusion disease-modifying therapies. Remember that these are generally billed twice, once for the cost of the drug and once for the cost of the administration.Medicaid (also called Medical Assistance): If you have limited income (under about $1,000 per month if you’re single) and limited assets you should apply for Medicaid in the state where you live. Medicaid will pay participating doctors, pharmacists, hospitals, or other providers for your care. Find Medicaid’s contact information.
    • MS Navigator Tip: If you’re low income but not eligible for Medicaid, ask if your state offers a “spend down” or “medically needy” program that can help you get Medicaid benefits.
    Medicare Savings Program (MSP): Also available through Medicaid, MSP may help with Medicare A and/or B costs, although eligibility is limited to individuals who have low income (around $1,350/month for an individual or $1,800/month if you’re married) and limited assets. Learn more about eligibility guidelines in your state, and contact Medicaid if you wish to apply.Nonprofit Funding: There are several nonprofits that help with Medicare prescription costs for the MS disease-modifying therapies. Their assistance will count toward your out-of-pocket costs to get you through the donut hole more quickly.
    • MS Navigator Tip: If these programs don’t have funds when you call, you are encouraged to check back as often as possible (daily, if that is an option) to see if their funding status has changed.
    • MS Navigator Tip: The Patient Access Network offers a FundFinder notification service for people in need of funding for MS therapies and premium assistance. Once a free account has been created, validated and the Multiple Sclerosis programs selected, users will receive updates when a program receives new funding. Register here.
    Pharmaceutical Assistance Programs: When all other resources have been exhausted, contact your drug manufacturer's Patient Assistance Program to request help with making your medication affordable. Tell them that you cannot adhere to your treatment without assistance. Realize, though, that pharmaceutical company funding is not always available for Medicare recipients and any assistance they provide will not count towards your out-of-pocket costs. When you call, explain that you cannot afford the cost of your treatment and that without the assistance program’s help you will not be able to adhere to your treatment.Help with the cost of infusion administration: If you need help specifically with the costs of administering your infusion medication, the following resources might also help:Some people with high healthcare costs may benefit from looking into other ways to get their Medicare. Programs such as Medicare Advantage Plans or Medigap can limit annual spending. MS Navigators are happy to discuss your coverage options. Contact an MS Navigator.

  • See a list of these programs to find the one that helps with your drug. When you call, explain that you cannot adhere to your prescribed medication without assistance.
    • MS Navigator Tip: Some pharmaceutical companies will help with infusion administration costs. These are often separate programs than the programs that assist with the cost of the drug itself.
    Contact your pharmaceutical program to ask if they offer help with infusion administration.The Assistance Fund's MS Copay Assistance Program - 877-245-4412.Drug discount cards and discount pharmacies: Drug discount cards can help to lower out of pocket costs at the pharmacy; they may be helpful for symptom management medications or some generic forms of MS disease-modifying therapies. Examples include lower cost dalfampridine (generic Ampyra) and dimethyl fumarate (generic Tecfidera) through programs such as GoodRx and Cost Plus Drug Company. The National MS Society does not recommend any specific drug discount services in large part because each individual we speak to has unique needs.To learn about drug discount cards or discount pharmacies that may help lower your costs, ask your trusted healthcare providers and pharmacists for their advice. Needymeds offers details about a number of drug discounts and RxAssist has a list of questions to ask to help you find a card or discount pharmacy that will work for you.Ask your health insurance plan if it gives the option to submit receipts for medications you purchased using a drug discount program so that your payment may count towards your annual out of pocket spending.
    • MS Navigator Tip: If your disease-modifying therapy is an infusion, make sure you’re using an infusion center that is in your plan’s network. If you pay a coinsurance (a percentage of the cost of the infusion administration, not a set copay amount), it’s in your interest to compare administration costs. Hospital-based infusion centers can be much more costly than stand-alone infusion centers. Search the Infusion Access Foundation’s Find an Infusion Center tool or ask your health insurance company and/or neurologist’s office for information about other infusion centers in your network.
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    Most disease-modifying medications prescribed for MS have patient assistance programs to help with the cost of the medication for people who are underinsured. See a list of these programs to find the one that helps with your drug. When you call, explain that you cannot adhere to your prescribed medication without assistance.
    • MS Navigator Tip: Some pharmaceutical companies will help with infusion administration costs. These are often separate programs than the programs that assist with the cost of the drug itself.
    Contact your pharmaceutical program to ask if they offer help with infusion administration.The Assistance Fund's MS Copay Assistance Program - 877-245-4412.Drug discount cards and discount pharmacies: Drug discount cards can help to lower out of pocket costs at the pharmacy; they may be helpful for symptom management medications or some generic forms of MS disease-modifying therapies. Examples include lower cost dalfampridine (generic Ampyra) and dimethyl fumarate (generic Tecfidera) through programs such as GoodRx and Cost Plus Drug Company. The National MS Society does not recommend any specific drug discount services in large part because each individual we speak to has unique needs.To learn about drug discount cards or discount pharmacies that may help lower your costs, ask your trusted healthcare providers and pharmacists for their advice. Needymeds offers details about a number of drug discounts and RxAssist has a list of questions to ask to help you find a card or discount pharmacy that will work for you.Ask your health insurance plan if it gives the option to submit receipts for medications you purchased using a drug discount program so that your payment may count towards your annual out of pocket spending.
    • MS Navigator Tip: If your disease-modifying therapy is an infusion, make sure you’re using an infusion center that is in your plan’s network. If you pay a coinsurance (a percentage of the cost of the infusion administration, not a set copay amount), it’s in your interest to compare administration costs. Hospital-based infusion centers can be much more costly than stand-alone infusion centers. Search the Infusion Access Foundation’s Find an Infusion Center tool or ask your health insurance company and/or neurologist’s office for information about other infusion centers in your network.

  • Medicaid to discuss why the costs for your medication are higher than you expected. There may have been an error in the pharmacy’s billing.If the cost is still too high, you might be able to negotiate a reduced price or payment plan, or may be able to get help with other needs to free up your budget to pay the medical bill. Learn more at the Patient Advocate Foundation." c-nmssatomrichtext_nmssatomrichtext-host="">
    Contact Medicaid to discuss why the costs for your medication are higher than you expected. There may have been an error in the pharmacy’s billing.If the cost is still too high, you might be able to negotiate a reduced price or payment plan, or may be able to get help with other needs to free up your budget to pay the medical bill. Learn more at the Patient Advocate Foundation.

    • I Need Help With Medical Bills or With a Drug That Isn’t a Disease-Modifying Therapy

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