Help Paying for an Infusion or Specialty Drug

Yes. Most makers of expensive infused and specialty drugs run a Patient Foundation (a patient assistance program, or PAP) that provides the medicine at no cost to patients who are uninsured, or whose insurance will not cover that specific drug, and who fall under an income limit (commonly up to 400% to 500% of the federal poverty level, with hardship reviewed higher). Your prescriber’s office submits the request, and once approved the drug is shipped to your doctor or infusion center for your treatments. For example, the Genentech Patient Foundation gives Genentech medicines free to eligible patients and does not require citizenship information. You apply through your doctor, not the pharmacy.

They help different people. A manufacturer FOUNDATION (PAP) gives the actual drug free and is meant for uninsured or underinsured patients under an income limit. A manufacturer COPAY CARD is for people with commercial or employer insurance that already covers the drug; it pays down your coinsurance or copay, often to close to $0, up to an annual maximum. Copay cards cannot be used by people on Medicare or Medicaid because of federal rules. Medicare patients use independent charity foundations (like the PAN or HealthWell Foundation) for that same help instead.

Site of care is the single biggest cost lever for an infused drug. The identical drug and dose are often billed two to three times higher at a hospital outpatient department than at a standalone infusion center, a doctor’s office, or through home infusion, because hospitals add a large facility markup on top of the drug. If you are stable, ask your prescriber whether your infusion can be moved to a lower-cost site. It can cut both your share and your plan’s cost substantially, without changing the medicine.

Manufacturer copay cards are off-limits on Medicare, but you have other levers. Independent charity foundations (PAN Foundation, HealthWell, Good Days, Patient Advocate Foundation) run disease-specific funds that cover coinsurance for Medicare patients when a fund is open. Medicare Extra Help (the Part D Low-Income Subsidy) lowers Part D drug costs if your income qualifies. And for Part B infused drugs, site of care still applies. If your income is limited, also check whether you qualify for help paying for Medicare.

Applying to any of these programs is free, and this tool is free. CareRoute earns money only on Bill Defense, where we review and negotiate a medical bill you already have, and only if we save you money. An infusion or specialty-drug bill is one of the highest-value bills to send us, whether it is a facility overcharge, a coding error, or a balance you should not owe once assistance is applied.