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Disclaimer

Disclaimer

Program Disclaimer

PAF’s Co-Pay Relief (CPR) program provides direct financial assistance to qualified patients with co-payments, co-insurance or cost-sharing associated with prescription drugs through funds dedicated to specific disease states. In some instances, assistance with insurance premiums and/or ancillary services associated with the disease also may be available. In order to qualify for a given disease-specific fund, an applicant must (1) have a diagnosis for the given disease, (2) have a treatment regimen in place, (3) have and maintain health insurance and (4) meet the financial criteria set forth by CPR for the fund.

PAF will not consider the identity of any physician, provider, supplier of items or services, donor, drug therapy, services or supplies being utilized or the referral source when assessing whether an applicant is qualified for financial assistance from a PAF CPR disease-specific fund. Under no circumstances will PAF recommend or refer an applicant or enrollee to any fund donor, provider, supplier or product.

Qualifying applicants are enrolled in a disease-specific fund for up to one year from the date of enrollment. Enrollment in a disease state fund for financial assistance up to the maximum grant amount is a gift to the enrollee, based on the availability of funding, and conditioned on use of the financial assistance in the one-year period from the date of enrollment. The financial assistance must be used for co-payments, co- insurance, or cost-sharing associated with medications prescribed to treat and/or manage the enrollee’s disease or condition (and in some instances insurance premiums and/or ancillary services depending on the disease state fund) up to the maximum grant amount set for the disease-specific fund, based on the availability of funding. PAF has no contractual obligation to provide such assistance to an enrollee. Enrollees must re- apply annually to continue receiving assistance from a given disease-specific fund, which is provided on a first come, first serve basis to the extent funding is and remains available.

Financial assistance from any CPR disease-specific fund is not dependent on the use of a particular drug or provider. Enrollees are provided assistance with all therapeutic, curative and supportive medications, including branded, generic and biosimilar products, that are prescribed to treat and/or manage the disease covered by the disease-specific fund. In the event that an enrollee is denied assistance with a therapeutic, curative or supportive medication that was prescribed to treat and/or manage the disease covered by the disease-specific fund, the enrollee should contact PAF CPR at 1-866-512-3861. Enrollees are free to switch drug therapies, treating physicians, pharmacies and suppliers at any time without affecting their continued eligibility for financial assistance from a disease-specific fund.

Enrollees are required to inform PAF in the event their financial circumstances change and/or they lose their health insurance coverage during their enrollment period as such changes may affect enrollee eligibility for a given CPR fund.

Enrollees’ contact information may be used in the future to share printed and/or electronic communications from Patient Advocate Foundation and the PAF Co-Pay Relief Program. If the enrollee does not wish to receive print and/or electronic communications from PAF and/or CPR, he/she may contact the program at 1-866-512-3861 and request to have his/her contact information removed from the mailing list.

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