Patient Assistance Programs: Free or Low-Cost Medications (2026 Guide)
Prescription drugs you cannot afford may be available at no cost directly from the manufacturer. Nearly every major pharma company runs a Patient Assistance Program (PAP), and millions of Americans qualify. This guide covers the biggest programs, exact income thresholds, application steps, and what to do if you get denied.
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What PAPs Are and Who Qualifies
A Patient Assistance Program (PAP) is a manufacturer-sponsored program that provides brand-name prescription drugs at no cost (or very low cost) to patients who meet specific eligibility criteria. These are not coupons or temporary discounts. When you are enrolled in a PAP, the manufacturer ships the actual medication, typically a 90-day supply, either to your doctor’s office or directly to your home.
Drug companies are not required by law to offer PAPs, but nearly all of them do. The pharmaceutical industry provided more than $14 billion in free medications through these programs in recent years. For patients taking specialty drugs that cost $5,000 to $15,000+ per month, a PAP can be life-changing.
Typical eligibility requirements
Important: household size matters
FPL thresholds scale with household size. A family of four at 400% FPL has an income ceiling around $128,400. If your individual income is above the single-person limit, check the threshold for your actual household size before assuming you are ineligible.
Major Manufacturer Programs
Below are the largest and most widely used PAPs. Each program has its own application, income rules, and covered medications. We have included the key details so you can determine which programs apply to your situation.
Pfizer RxPathways
Pfizer RxPathways is one of the largest PAPs in the country. It covers a massive range of medications including Ibrance (breast cancer), Xeljanz (rheumatoid arthritis), Eliquis (through co-marketing with BMS), Prevnar vaccines, and dozens of cardiovascular, anti-infective, and specialty drugs. The program also connects patients to independent copay foundations if they have insurance. Pfizer offers a dedicated phone line (1-844-989-7284) with case managers who walk patients through the application. Processing typically takes 2 to 3 weeks, and the program provides 90-day medication supplies shipped to the prescriber’s office.
Lilly Cares
Lilly Cares is the PAP arm of Eli Lilly, and it is especially important for patients who need insulin. The program covers Humalog, Humulin, Basaglar, and other Lilly insulins at no cost for qualifying patients. Lilly also runs the Insulin Value Program, which caps insulin at $35 per month for commercially insured patients, but the Lilly Cares PAP provides insulin completely free for uninsured patients who meet income requirements. Other covered drugs include Trulicity (type 2 diabetes), Verzenio (breast cancer), and Mounjaro (type 2 diabetes and weight management). If you need insulin and are struggling with cost, also see our insulin cost guide for additional strategies.
myAbbVie Assist
AbbVie’s patient assistance program is notable for its fast turnaround. Applications are often reviewed within two business days, and bridge supplies can be provided while the full application is processed. Humira (adalimumab) remains one of the most prescribed specialty drugs in the U.S. and has a list price exceeding $7,000 per month. For uninsured patients below the income threshold, myAbbVie Assist provides Humira at no cost. The program also covers Rinvoq (upadacitinib) for rheumatoid arthritis and atopic dermatitis, Skyrizi (risankizumab) for plaque psoriasis and Crohn’s disease, and Imbruvica for certain blood cancers. AbbVie also operates a separate copay assistance program for commercially insured patients facing high out-of-pocket costs.
Johnson & Johnson Patient Assistance Foundation
J&J’s Janssen Pharmaceutical division runs one of the more generous PAPs, with income limits reaching 500% FPL for many medications. Stelara (ustekinumab), used for Crohn’s disease and psoriasis, lists at over $26,000 per injection, making this program essential for uninsured patients. Tremfya (guselkumab) for plaque psoriasis, Xarelto (rivaroxaban) for blood clot prevention, and Darzalex (daratumumab) for multiple myeloma are also covered. J&J operates the Janssen CarePath program alongside the PAP to help commercially insured patients with copay assistance. Applications can be submitted online, by fax, or by phone at 1-800-652-6227.
Merck Patient Assistance Program
Merck’s PAP is critically important for cancer patients who need Keytruda (pembrolizumab), the most prescribed immunotherapy drug in the U.S. A year of Keytruda treatment can cost over $190,000 at list price. The Merck PAP provides Keytruda free to eligible patients, and the program evaluates applications on a case-by-case basis for patients slightly above the standard income threshold. Januvia and Janumet for type 2 diabetes are also covered. Merck operates the Merck Helps program (1-800-727-5400) as the central phone line for all patient assistance inquiries.
Bristol-Myers Squibb Patient Assistance Foundation
BMS runs its PAP through the Bristol-Myers Squibb Patient Assistance Foundation. Eliquis (apixaban), one of the most commonly prescribed blood thinners in the U.S., is available through this program for uninsured patients. At a retail price of roughly $600 per month, the savings are significant. For oncology patients, BMS provides Opdivo (nivolumab) and Revlimid (lenalidomide), both extremely expensive immunotherapy and cancer drugs. BMS also offers a bridge supply program for patients awaiting PAP approval. Contact BMS Access Support at 1-800-861-0048.
Genentech Access Solutions
Genentech (a Roche subsidiary) has one of the most comprehensive PAPs in oncology and autoimmune disease. Their Access Solutions program covers Herceptin (trastuzumab) for breast cancer, Avastin (bevacizumab) for multiple cancer types, Rituxan (rituximab) for lymphoma and rheumatoid arthritis, and Ocrevus (ocrelizumab) for multiple sclerosis. The income ceiling is generous at 500% FPL, and the program specifically evaluates financial hardship for patients who fall slightly above the threshold. Genentech also offers copay assistance and free drug replacement if a dose is damaged or lost. Reach them at 1-866-422-2377.
AZ&Me (AstraZeneca)
AstraZeneca’s AZ&Me program covers a broad portfolio spanning respiratory, cardiovascular, diabetes, and oncology medications. Symbicort (budesonide/formoterol) for asthma and COPD, Farxiga (dapagliflozin) for type 2 diabetes and heart failure, Tagrisso (osimertinib) for lung cancer, and Lynparza (olaparib) for ovarian and breast cancer are all included. AstraZeneca also runs a separate program for Nexium (esomeprazole) for patients with chronic GERD. The AZ&Me application can be submitted online, and the program has a reputation for relatively quick processing. If you take a GLP-1 medication, check our Ozempic and GLP-1 cost guide for additional savings strategies.
Quick Comparison: Income Limits at a Glance
| Manufacturer | Program Name | FPL Limit | Single Person ~Income |
|---|---|---|---|
| Pfizer | RxPathways | 400% | ~$62,400 |
| Eli Lilly | Lilly Cares | 400% | ~$62,400 |
| AbbVie | myAbbVie Assist | Up to 500% | ~$78,000 |
| J&J / Janssen | J&J PAF | 500% | ~$78,000 |
| Merck | Merck Helps | 400% | ~$62,400 |
| BMS | BMS PAF | 300%+ | ~$46,800+ |
| Genentech | Access Solutions | 500% | ~$78,000 |
| AstraZeneca | AZ&Me | 400% | ~$62,400 |
Step-by-Step Application Process
Every PAP application follows a similar structure. Here is the process from start to finish, including the parts most guides leave out (like getting your doctor’s office to actually complete their section on time).
Identify the manufacturer and program
Look up your medication at NeedyMeds.org or the Medicine Assistance Tool (medicineassistancetool.org). These databases list every available PAP by drug name. Note the manufacturer name, program name, and the specific application URL or phone number.
Check your eligibility before applying
Verify the income threshold, insurance requirements, and residency rules before downloading the application. If you are close to the income limit, check whether the program uses individual income, household income, or adjusted gross income (AGI). Some programs use AGI from your most recent tax return, which may be different from your current earnings.
Complete the patient section of the application
Fill in your personal information, insurance status, income information, and sign the form. Most applications are 2 to 4 pages. Be thorough but do not overthink it. Common required documents include your most recent tax return (Form 1040, first two pages), recent pay stubs, or a signed income attestation letter.
Get your doctor’s office to complete their section
This is where most applications stall. Your prescribing physician must fill out the provider section, which typically includes the prescription details, the doctor’s DEA number, NPI, and office address, plus a physician signature. Many practices have a patient assistance coordinator, financial counselor, or social worker who handles this routinely.
Pro tip: Call your doctor’s office before dropping off the application. Ask who handles PAP paperwork, bring the form with your section already completed, and ask for a specific turnaround date. If you do not follow up, the form can sit on a desk for weeks.
Submit the application
Submission methods vary. Some programs accept online submissions through a patient portal. Others require fax (yes, fax is still standard in healthcare) or mail. If you are faxing, keep a confirmation page. If mailing, use certified mail with tracking. Many programs also allow the doctor’s office to submit on your behalf, which can speed things up.
Wait for approval (and ask about bridge supply)
Processing takes 2 to 4 weeks for most programs. While you wait, ask the manufacturer if they offer a bridge or quick-start supply. Many companies will send a 30-day emergency supply while the full application is processed. See the gap coverage section below for more options.
Re-enroll annually
Most PAPs require annual re-enrollment with updated income documentation. Set a calendar reminder 30 days before your enrollment expires. Some programs send renewal notices, but many do not. If your enrollment lapses, you will need to reapply from scratch, which means another gap in medication supply.
Common Rejection Reasons and How to Appeal
PAP denials are common, but most are fixable. Here are the top reasons applications get rejected and what to do about each one.
Incomplete application or missing documents
This is the number one reason for denial. A missing signature, an unsigned provider section, or forgetting to attach proof of income will result in an automatic rejection.
Fix: Call the program, ask exactly what was missing, resubmit the completed form. Most programs let you resubmit without starting over.
Income above the program threshold
If your income is slightly above the FPL cutoff, do not give up. Some programs have hardship exceptions or evaluate financial burden on a case-by-case basis, particularly for expensive specialty and oncology medications.
Fix: Call the program and explain your situation. Ask if there is a hardship review process. If your income recently dropped due to job loss or medical expenses, provide documentation of your current income rather than your last tax return. Also consider copay foundations (PAN Foundation, HealthWell Foundation) as an alternative.
You have insurance that covers the drug
Most PAPs are designed for uninsured or underinsured patients. If your insurance formulary lists the medication as covered (even with a high copay), you may not qualify for the PAP.
Fix: Look into the manufacturer’s copay assistance card instead (different from the PAP). Also explore independent copay foundations. If your insurance covers the drug but you still cannot afford the copay, you may also qualify for other prescription savings strategies.
Medicaid enrollment
Patients with Medicaid coverage are typically excluded from PAPs because Medicaid already provides medications at very low cost. However, if Medicaid does not cover a specific drug you need, some manufacturers will make exceptions.
Fix: Confirm with your Medicaid plan that the drug is truly not covered. If it is not, ask the manufacturer if they accept Medicaid patients when the drug is not on the Medicaid formulary. Your doctor can also request a Medicaid formulary exception or prior authorization.
Duplicate application or already enrolled
Some manufacturers flag applications when a patient (or the same prescriber) has already submitted one. This can happen if your doctor’s office resubmitted without realizing you had already applied.
Fix: Call the program to clarify. If you submitted a previous application that was denied or withdrawn, explain the situation and ask them to process the new application.
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Gap Coverage: What to Do While Waiting for Approval
A 2 to 4 week wait can be dangerous if you need the medication now. Here are options to bridge the gap between submitting your application and receiving your first PAP shipment.
Manufacturer bridge programs
Many manufacturers offer a free 30-day supply while your PAP application is being reviewed. Ask about this when you call the program. AbbVie, Genentech, and BMS are among those known for offering bridge supply. Some call it a “quick-start” or “emergency supply” program.
Doctor samples
Your prescriber may have manufacturer samples on hand. These are the same medication in smaller quantities. Ask your doctor if samples are available to cover the gap. This is especially common for newer brand-name drugs that pharmaceutical reps are actively promoting.
Copay cards (if insured)
If you have commercial insurance but are awaiting PAP approval, check if the manufacturer has a copay savings card that can temporarily reduce your out-of-pocket cost. These often reduce copays to $0 to $25 per fill. They are not available for Medicare or Medicaid patients.
Community health centers and 340B pharmacies
Federally Qualified Health Centers (FQHCs) and 340B-covered entities purchase drugs at deep discounts and may pass savings to patients. Use the HRSA 340B database at hrsa.gov to find locations near you. This can be a lifeline while you wait for PAP approval.
Never skip doses of critical medications
If you take medication for a chronic condition (blood pressure, diabetes, seizures, blood thinners, HIV), skipping doses can cause serious health consequences. If you cannot afford a refill and your PAP is still processing, call your doctor immediately and explain the situation. They can often provide samples, authorize an emergency fill, or contact the manufacturer to expedite your application.
Aggregator Tools: Find Every Program in One Place
You do not need to search each manufacturer’s website individually. These three free databases aggregate PAP information across all major drug companies, making it easy to find every program you may qualify for.
NeedyMeds (needymeds.org)
NeedyMeds is the most comprehensive free database for patient assistance programs. Search by drug name to find every available PAP, copay card, and charitable foundation that covers your medication. The database lists over 6,000 assistance programs, including manufacturer PAPs, state programs, disease-specific foundations, and discount pharmacy programs. NeedyMeds also offers a free drug discount card that works at most major pharmacies.
Free to use, no registration required for basic searches.
RxAssist (rxassist.org)
RxAssist is maintained by Volunteers in Health Care and provides a curated, regularly updated directory of patient assistance programs. It is especially useful for healthcare professionals and social workers who help patients navigate applications. The database is searchable by drug name, manufacturer, or condition. RxAssist also publishes guides and training materials on how to effectively apply for PAPs.
Free to use, particularly helpful for healthcare navigators.
Medicine Assistance Tool (medicineassistancetool.org)
The Medicine Assistance Tool (MAT) is operated by PhRMA, the pharmaceutical industry trade group. Because it is run by the industry itself, it covers every PAP offered by its member companies. Enter your medications, answer a few questions about your income and insurance, and MAT returns a list of programs you may qualify for, along with links to each application. It is a good starting point if you take multiple brand-name medications from different manufacturers.
Free to use, sponsored by PhRMA member companies.
For a broader view of prescription savings strategies beyond PAPs, see our complete guide to lowering prescription drug costs, which covers discount cards, generic switches, 340B pharmacies, mail-order savings, and more.
Uninsured vs. Underinsured: Which Programs Apply to You?
This distinction trips up a lot of people. “Uninsured” and “underinsured” are not interchangeable terms, and different programs target different groups.
Uninsured
You have no health insurance at all, or your insurance does not include any prescription drug coverage.
Programs available to you:
- Manufacturer PAPs (your primary option)
- State pharmaceutical assistance programs (SPAPs)
- Community health center sliding-scale pharmacies
- Prescription discount cards (GoodRx, RxSaver, SingleCare)
Underinsured
You have insurance, but your plan does not cover a specific medication, or your copay/coinsurance is unaffordable (often 20% to 40% of a specialty drug’s cost).
Programs available to you:
- Manufacturer copay assistance cards
- Independent copay foundations (PAN, HealthWell, Patient Advocate Foundation)
- PAPs (only if your insurance does not cover the specific drug)
- Prescription discount cards (may beat your copay for some generics)
Medicare Part D patients
If you have Medicare Part D, you occupy a unique middle ground. Many manufacturer PAPs do accept Medicare patients, especially during the coverage gap (the “donut hole”). You may also qualify for Medicare Extra Help (Low-Income Subsidy), which reduces your Part D premiums and copays. Apply for Extra Help through the Social Security Administration at ssa.gov.
If you are dealing with high medical bills beyond just prescription costs, CareRoute’s Bill Defense service can help you navigate the full picture, from drug costs to hospital bills to insurance disputes.
Frequently Asked Questions
What is a patient assistance program (PAP)?
A PAP is a program run by a pharmaceutical manufacturer that provides free or very low-cost brand-name medications to patients who cannot afford them. These programs are distinct from copay cards (which reduce copays for insured patients) and discount cards (like GoodRx, which negotiate lower cash prices at pharmacies). When you are enrolled in a PAP, the manufacturer provides the actual medication, usually in 90-day supplies, at no charge.
What are the income limits for patient assistance programs?
Income limits vary by manufacturer. Most programs set the ceiling at 300% to 400% of the Federal Poverty Level (FPL). For 2026, 400% FPL is approximately $62,400 for a single person and $128,400 for a family of four. Several oncology and specialty programs extend to 500% FPL (~$78,000 for a single person), and some evaluate financial hardship on a case-by-case basis with no strict cap.
Can I get patient assistance if I have health insurance?
It depends. Most PAPs are designed for uninsured patients or patients whose insurance does not cover the specific medication. If you have insurance that covers the drug but your copay is too high, look into manufacturer copay cards or independent copay foundations (PAN Foundation, HealthWell Foundation). Medicare Part D patients often qualify for PAPs if they meet the income threshold. Medicaid patients generally do not qualify because Medicaid should already cover the medication at low cost.
How long does it take to get approved?
Most programs take 2 to 4 weeks from submission to approval. Some programs (like myAbbVie Assist) can process applications within two business days. Delays are almost always caused by incomplete applications or missing documentation. Many manufacturers offer bridge or quick-start supply programs that provide a 30-day emergency supply while your full application is reviewed. Always ask about bridge supply when you submit.
Do PAPs cover generic medications?
Generally, no. PAPs are manufacturer programs designed to provide their own brand-name products. If a generic version of your medication is available, it is usually affordable enough that a PAP is unnecessary. For generic savings, use discount cards like GoodRx, RxSaver, or Cost Plus Drugs. If you need a brand-name drug because the generic is not available or is not therapeutically equivalent, then the PAP is the right path.
What if my application is denied?
First, call the program and ask for the specific reason. Incomplete paperwork is the most common cause and is easily fixable. If you are over the income limit, ask about hardship exceptions. If your insurance disqualifies you, explore copay assistance programs instead. You can also look into independent copay foundations (PAN Foundation, HealthWell Foundation, Patient Advocate Foundation) or state pharmaceutical assistance programs (SPAPs). See our section on rejection reasons and appeals for detailed guidance.
Do I need a doctor to apply?
Yes, every PAP requires a prescribing physician to co-sign the application. Your doctor must provide their DEA number, NPI, office address, and verify the prescription. Many programs also ship the medication directly to the doctor’s office rather than to the patient’s home. If your doctor’s office is not familiar with PAP applications, ask if they have a social worker, financial counselor, or patient navigator who can help. Hospital-based clinics and oncology offices typically have dedicated staff for this.
Can I apply to multiple PAPs at once?
Yes. If you take multiple brand-name medications from different manufacturers, you can (and should) apply to each manufacturer’s PAP separately. Each application is independent. Use NeedyMeds.org or the Medicine Assistance Tool to identify all the programs you qualify for, then submit applications in parallel. There is no rule against being enrolled in multiple PAPs simultaneously.
Related Resources
Lowering Prescription Drug Costs
12 proven strategies to reduce what you pay for medications, from discount cards to generic switches to mail-order pharmacies.
Read guideInsulin Cost Guide
How to get insulin at the lowest possible cost, including the $35 cap, Lilly Cares, Novo Nordisk PAP, and state-level assistance programs.
Read guideOzempic and GLP-1 Cost Guide
Strategies to reduce the cost of Ozempic, Mounjaro, Wegovy, and other GLP-1 medications for diabetes and weight loss.
Read guideStop Overpaying for Prescriptions
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