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Patient Assistance Programs: Who Qualifies for Free Medicine From the Drug Maker, and How to Apply

October 20, 20269 min read
Patient Assistance Programs: Who Qualifies for Free Medicine From the Drug Maker, and How to Apply

If a cancer drug costs more than you can pay, the company that makes it may give it to you for free. Most brand-name drug makers run a patient assistance program, or PAP, for people who are uninsured, whose insurance won't cover the drug, or who have coverage but still can't afford their share. Many of these programs accept people on Medicare. Income limits are often generous, in some cases up to five times the federal poverty level, which for a single person in 2026 means up to $79,800 a year. This post explains who qualifies, what you'll need, and how to apply, step by step.

This is a deeper look at one part of our earlier guide, How to Get Financial Help Paying for Cancer Treatment. If you haven't read that yet, it covers the full picture: hospital charity care, copay foundations and grants.

What is a patient assistance program?

A patient assistance program is a charity-style program run by a drug company that gives its own medicines free, or at very low cost, to people who can't afford them. Companies offer these programs voluntarily. The government doesn't require them, and it doesn't run them.

PAPs are different from copay cards, the coupons drug companies hand out to people with commercial insurance. A copay card lowers your copay at the pharmacy. A PAP skips the pharmacy entirely: the company ships the drug to you or your doctor's office. That difference matters for Medicare, as you'll see below.

Each company sets its own rules, so every program is a little different. But most share the same shape: an income limit, an insurance test, a form your doctor signs, and a one-year enrollment you renew.

Who qualifies?

You usually need to fit one of three situations:

  • You have no health insurance or no prescription coverage.
  • You have insurance, but it doesn't cover this drug. A denial letter from your plan helps here.
  • You have insurance that covers the drug, but your share is still more than you can afford. Not every program accepts this group, but several large ones do.

Then there's an income limit. Programs set it as a percentage of the federal poverty level, the yearly income figure the government publishes each January. For 2026, the poverty level in the 48 contiguous states and D.C. is $15,960 for one person, $21,640 for two, and $33,000 for a family of four. Programs commonly allow 300% to 500% of that. In dollars:

  • 300% of the poverty level: $47,880 for one person, $99,000 for a family of four.
  • 400%: $63,840 for one person, $132,000 for a family of four.
  • 500%: $79,800 for one person, $165,000 for a family of four.

Alaska and Hawaii have higher limits. The income most programs ask for is your adjusted gross income, the number on line 11 of your most recent federal tax return, counting you, your spouse and your dependents.

Two more things many people don't expect:

  • You don't have to be a U.S. citizen. Several major programs accept legal residents, and at least one says it doesn't collect citizenship information at all. You do need to live in the U.S. and be treated by a U.S.-licensed doctor.
  • You can ask for an exception. Some programs will consider you even if you miss the insurance test, if you can show financial and medical hardship.

Can I use a PAP if I'm on Medicare?

Often, yes. This is the biggest difference between PAPs and copay cards.

Copay cards can't be used with Medicare, Medicaid or other federal programs. PAPs are treated differently. Back in 2005, the federal Office of Inspector General said a drug maker may give free drugs to Medicare Part D enrollees as long as the program runs entirely outside the Part D benefit: the plan is told, the plan pays nothing, and the company keeps clean records. Many manufacturer programs are set up exactly this way, and some say plainly that they accept people with Medicare who still can't afford their drug.

Three things to know if you're on Medicare:

  • Free PAP drugs don't count toward your Part D cap. In 2026, once you've spent $2,100 out of pocket on covered Part D drugs, you pay nothing more for them that year. But the government's rule is that help from a program outside Part D must not count toward that total. So a PAP takes one drug off your bill; it doesn't move you closer to the cap for your other drugs.
  • Your enrollment may end on December 31. At least one large program says Part D members' enrollment ends at the end of the calendar year, not twelve months from sign-up. Another says Medicare patients will not be re-enrolled automatically for 2027. Put a reminder in November.
  • Not every company says yes. Some accept Part D members outright, some review case by case. Ask before you assume either way.

If you have Medicare and a modest income, also look at Extra Help, the federal program that lowers Part D costs. We covered it in the earlier guide.

What do you actually get?

The drug itself, free, usually for up to a year per application. Details that are typical of large programs:

  • Shipped to you or your doctor. Pills usually go to your home. Drugs given by infusion or injection at the clinic go to your doctor's office, which gives them to you at your appointment.
  • Up to a 90-day supply at a time, with refills shipped automatically or after you confirm your address.
  • No fees, ever. Applying is free, and the review is free. If someone offers to fill out the forms for a fee, you don't need them, and the drug makers say they have nothing to do with those services.
  • Renewal once a year. You reapply with fresh income proof. The program will usually tell you before your enrollment ends.

What do real programs look like?

Here are three large manufacturers' programs as published on their own sites in October 2026. They're examples, not a complete list, and rules change, so confirm before you count on anything.

  • Merck Patient Assistance Program. For its cancer medicines, the income limit is $79,800 for one person, $108,200 for a couple and $165,000 for a family of four, which is 500% of the 2026 poverty level. It is mainly for people with no insurance for the drug, with a hardship exception. One application can cover up to a year of free medicine, you can reapply as often as needed, and the program says a complete form is typically processed in under 7 business days with medicine arriving in under 10. It's a mail-in program. Phone: 1-800-727-5400.
  • AZ&Me (AstraZeneca). For people with no health insurance and for people on Medicare who still can't afford their AstraZeneca drug. It asks for household size and adjusted gross income from your Form 1040. Apply online and you may get a decision immediately; by fax, expect 2 to 4 business days. Approved patients get up to a 90-day supply delivered to their home or doctor's office. Medicare patients must re-enroll for 2027. Phone: 1-800-292-6363.
  • Genentech Patient Foundation. Helps three groups: people with no insurance, people whose insurance doesn't cover their Genentech medicine, and people who have coverage but can't afford their out-of-pocket costs. Two forms are required, a patient consent form you complete and a prescriber form your doctor completes, and the foundation says it processes a complete request within 5 business days. It doesn't collect citizenship information. Phone: 1-888-941-3331.

To find the program for your specific drug, use a free directory. The National Cancer Institute points people to NeedyMeds, which lists assistance programs for more than 3,800 drugs and is searchable by drug name, and to RxAssist. The drug industry's own search engine, America's Medicines (run by PhRMA, the trade group), also lists manufacturer programs. None of these take applications; you apply to each company directly.

How to apply, step by step

  1. Write down the exact name of each drug, including how it's given (pill, injection, infusion). Programs are drug-specific.
  2. Look up each drug's program on NeedyMeds, RxAssist or America's Medicines, or search the manufacturer's name plus "patient assistance." Note the phone number and whether the form is online, fax or mail.
  3. Gather your paperwork. Your most recent federal tax return (or pay stubs or a benefits letter if you haven't filed), your insurance card or a statement that you have none, any denial letter from your plan, and your doctor's name and office address.
  4. Tell your doctor's office you're applying. Every program needs the prescriber to sign a form or send a prescription. Ask who in the office handles assistance forms; many oncology practices have a financial counselor or coordinator who does this weekly.
  5. Fill in every line. Write "0" or "none" rather than leaving blanks. Incomplete forms are the most common reason for delay.
  6. Submit it the way the program wants, and keep a copy. If you give an email or cell number, most programs will confirm receipt and text you when medicine ships.
  7. Follow up after a week. Call the program if you haven't heard. If you need the drug urgently, say so; some programs have an expedited request line.
  8. Set two reminders: one for the renewal date, and for Medicare members, one for mid-November to re-enroll for the new year.

Three traps to avoid

  • Paid "application services." You never pay to apply to a PAP. Companies warn that fee-charging helpers are not connected to them.
  • "Alternative funding programs." Some employer health plans now refuse to cover expensive specialty drugs and instead push employees to apply to the manufacturer's charity program. Several manufacturers have responded by refusing patients whose plan requires a PAP application as a condition of coverage. If your plan is doing this, tell the program and your doctor's office, and ask your plan in writing why the drug isn't covered.
  • Letting enrollment lapse. Approval lasts about a year, and for Medicare members it may end December 31. A missed renewal can mean a missed dose while the paperwork restarts.

Where Arul fits

Arul is an AI care navigator that does this paperwork for you: it finds the right program for each drug, fills in the applications, chases the prescriber signature, and follows up with the program and your insurer. Nothing goes out in your name until you've approved it. If the steps above feel like one more job you don't have time for, that's the job Arul is built to take on. You can get started at arulhealth.com/get-started.

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