Avenues to Affordability

Medications can be cost-prohibitive for patients, particularly for highly-specialized therapies that may require a prior authorization (PA). Even after PA approval, patients may learn that their individual out-of-pocket cost is higher than expected. This concern is often escalated back to the patient’s care team, who then search for available assistance programs to support affordability. Knowing which programs are available and their eligibility requirements is a key aspect to the time-consuming work of searching for programs and combing through their qualifying criteria.

Financial Support Options

Copay Card

Copay Cards act like a coupon to lower the out-of-pocket cost of a brand name medication when copays are high. Generally, no formal application is required; however, the patient, or person acting on behalf of the patient such as a care team member, will need to register online to receive the Copay Card and then provide this information to the pharmacy. This type of financial support typically requires the patient to have commercial insurance coverage and does not apply to patients that are covered by government-funded insurance like Medicare, Medicaid, or Tricare.

Patient Assistance Program (PAP)

Patient Assistance Programs offer free medication directly from the manufacturer and apply to patients that are uninsured or underinsured, often including patients whose insurance does not cover the specific program medication. For a PAP to be approved, a formal application is submitted with documentation of the patient’s income, US residency, and documentation of insufficient insurance coverage, insurance denial, or lack of insurance.

Free Trial and Bridge

Free Trial, also known as Quick Start, and Bridge Programs may be available for patients that are pending prior authorization, during an appeal for a previously denied claim, or have other insurance coverage gaps. These options provide temporary free or low-cost medication to patients to ensure they are able to start medication as soon as possible or prevent treatment interruptions. For access to these programs, the physician’s office completes documentation to indicate delay in care or therapy gap, and then medication is shipped to the physician’s office or directly to the patient.

Foundations and Grants

Non-profit organizations also offer financial assistance to support patient healthcare related expenses not otherwise covered by insurance or alternate financial assistance programs. To receive support, a patient or patient advocate submits an application through the relevant Foundation or Charity organization’s website. These applications often require documentation of medical need, US residency, income, and lack of coverage. Income eligibility varies based on individual organization guidelines.

Cinnamon’s Coverage Waterfall

Cinnamon’s Coverage Waterfall algorithm evaluates patient information, including prescribed medications, insurance type (commercial, government, or uninsured), and other financial details, and compares it to eligibility requirements for financial assistance programs. It lightly pre-screens against foundation and patient assistance criteria to identify eligible options for a patient.

This type of approach replaces the time-consuming and often arduous manual research that would otherwise require staff to search manufacturer websites and program documentation individually. By proactively identifying available patient assistance pathways, the system highlights relevant opportunities and allows teams to begin applications quickly and directly, saving time and helping to ensure that qualified programs aren’t overlooked.

Contact us to learn more about how Cinnamon can benefit your organization

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