PAF Co-Pay Relief: Gout

Not Funded

About

The PAF Co-Pay Relief: Gout program provides essential financial assistance for patients prescribed with medications like Acthar Gel, Ilaris, Krystexxa, and others. The program is designed to support eligible patients with covered diseases in managing their treatment costs effectively. By participating in the PAF Co-Pay Relief: Gout program, beneficiaries can access immediate funding and must meet specific eligibility criteria, including insurance coverage and income verification.

Insurance requirements: Medicare / Medicaid

Enrollment Forms

Enrollment Form

Benefits

•$2000 annual maximum benefit

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•Specific drug coverage is not indicated on program website; drug coverage must be verified by calling program at 18665123861

•Patients may complete the application online or by phone; once approved, patients will begin receiving funding immediately

•All patients approved for assistance are required to have their diagnosis and treatment verified by a member of the patient’s care team within 30 days of approval

•The CoPay Relief Program will confirm the patient's reported income to ensure that it is within the income eligibility guidelines for the program through an income verification screening process

•If patient's reported income is unable to be verified, a letter will be sent requesting proof of income documents be submitted to our program within 30 days for continued eligibility. Approved patients who do not comply with the request for income documentation within 30 days will forfeit their award

•Approved patients who have a household income in excess of program guidelines upon review of submitted income documentation will no longer qualify for continued support, will forfeit their award and will not be eligible to reapply for the program until 12 months from the original date of approval

•Approved patients understand and agree that if they do not comply with the request for income documentation will no longer qualify for continued support, will forfeit their award and will not be eligible to reapply for the program until 12 months from the original date of approval

•Patients can continue to submit claims for payment during this income verification period

•Claims can be submitted to CPR for payment via Virtual Pharmacy Card, electronic upload into the portal, faxed using the unique barcoded fax cover sheet or mailed

•Claims can be paid via Virtual Pharmacy Card, Electronic Funds Transfer (EFT) or check

•Approved patients who exceed 120 days with no processed claims at any time during their 12 month award period will forfeit their award. Patients who forfeit their award due to lack of utilization are not eligible to reapply for the program until 12 months from the original date of approval. Uninsured patients are ineligible UNLESS they have had coverage within the previous 6 months

•Foundation covers all drugs that are FDAindicated for the diagnosis. If physician prescribes an offlabel medication, and the insurance company will pay for it, the foundation will also cover it

Enrollment Forms

Enrollment Form