Many people know that some drug manufacturers have Patient Assistance Programs (PAPs) to make prescription diabetes drugs free for those who meet certain eligibility requirements. In 2017, we did a six-month-long project looking into these programs to better understand how they are similar, how they are different, and who they can and can’t help. These programs are usually reserved for individuals without private insurance or full Medicare benefits, but some programs review applications on a case-by-case basis.

Finding information about these programs can be difficult, and even when you find the information, PAPs often have complicated income, insurance, and prescription requirements. In this article, we break down current PAPs in the US by manufacturer and give the details to help you find the right program. 

Each PAP program has a similar free application, regardless of the drug that you want help with – DPP-4 inhibitors, GLP-1 agonists, SGLT-2 inhibitors, or basal or fast-acting insulin, all of which are particularly expensive diabetes drugs that PAPs can help with. There is one portion to be filled out by the person who has been prescribed the drugs, and another to be completed by a doctor or nurse or one of their team. All programs require a prescription, but the applications vary in whether proof of income or particular insurance documentation is required. Here are some of the biggest learnings from our work on the ground looking at these programs:

• Boehringer-Ingelheim (BI), Merck, and Sanofi do not require proof of income for their products – among other drugs, BI makes Jardiance, Sanofi makes Lantus and Soliqua, and Merck makes Januvia.

• AstraZeneca, Johnson & Johnson, Lilly, Novo Nordisk, and Tadeka do require proof of income in the form of tax returns, pay stubs, or other statements.

• Most programs have income cutoffs.

  • Takeda has the most generous cutoff at $63,800 for a household of one or $131,000 for a household of four (five times the Federal Poverty Level).

  • More recently, Lilly, Merck, Novo Nordisk, and Sanofi have increased income cutoffs to four times the Federal Poverty Level – a welcome improvement. 

  • AstraZeneca has the strictest cutoff at $36,420 for an individual or $75,300 for a family of four.

• Most programs require that an applicant does not have private insurance and is not enrolled in Medicare, but one can still be eligible if he or she receives only Medicare Part D benefits. 

• In addition, if enrolled in Medicare, ruling out Low Income Subsidy (LIS) eligibility, which helps people with Medicare pay for prescription drugs, is a good practice before filling out a PAP. Click here for more information on LIS.

Not all PAPs are equal – there are factors like ease of application and less need for additional paperwork that differentiate the easy ones from the difficult ones. Keep an eye out for this “diaTribe Stamp of Approval” that acknowledges particularly helpful programs, which use the following criteria:

• Household income cutoffs should be calculated at (or more than) four times (400%) of the Federal Poverty Level (FPL).

  • In 2020, this means at or under $51,040 for an individual, $68,960 for a couple, or $104,800 for a family of four.

• The application should be relatively easy to read and fill out for people with diabetes and healthcare professionals.

• Additional paperwork requirements should not be too burdensome.

• Duration of supply, if the application is approved, should be longer than three months. 

Click here to jump down to learn more about application requirements specific to the medication you need.

• Because PAPs are organized by manufacturer and not specific drugs, you can get assistance for multiple drugs from the same manufacturer without filling out multiple applications.

• Being enrolled in one manufacturer’s PAP does not prevent you from applying to a different manufacturer’s PAP, as long as you also have a prescription for that company’s drug.

• A general rule of thumb is that you cannot use a PAP for a drug while accepting another form of assistance or government reimbursement for the same drug.

diaTribe reached out to a number of health professionals about their experiences with PAPs. While those working in private healthcare offices are sometimes less familiar with these programs, providers in community health clinics are often aware of how to use them. Unfortunately, many providers with whom we spoke found organizing the qualification requirements (like tax forms and income statements) and the additional paperwork involved in applying for PAPs to be burdensome. If you believe you would qualify for a PAP, here are some strategies to get your healthcare professional to help you apply:

1. 

   In addition to your own personal information, fill out everything you can in the rest of the application, even in the healthcare professional section, such as your physician’s name, address, phone number, etc.

2. Review the form before going to your healthcare professional’s office so you know what additional documents that the application requires – this will include proof of income (except for Merck and Sanofi’s PAPs), copies of tax forms, proof of Medicare denial, etc. In the next section of this article, you can find the requirements for each PAP.

3. Try to bring an addressed envelope with the appropriate postage. You can order postage stamps online here.

4. Emphasize to your healthcare professional that you’ve done all that you can to fill in the forms wherever possible and their help is necessary for you to access the drugs they are prescribing and that filling out the application would be just about ten minutes of their time!

5. Make copies of the forms beforehand, since you might be asked to leave them behind in the office.

6. Ask when you can follow up to make sure the provider does not have further questions of you (and to kindly make sure the forms are sent).

Note: keep records of your taxes! If you don’t have a copy of your federal income tax return, click here to learn how to get one.

Each drug manufacturer has the same assistance program for all of its drugs. If you’re not sure what company manufactures your medication, click on a diabetes drug from the list below to jump down to details about the associated assistance program.

• Basal insulins (long-acting)

  • Basaglar (Lilly)

  • Lantus (Sanofi)

  • Levemir (Novo Nordisk)

  • Toujeo (Sanofi)

  • Tresiba (Novo Nordisk)

• Fast-acting (mealtime) insulins

  • Amdelog (Sanofi)

  • Apidra (Sanofi)

  • Fiasp (Novo Nordisk)

  • Humalog (Lilly)

  • NovoLog (Novo Nordisk)

• Regular/NPH (Human) insulins

  • Humulin (Lilly)

  • Novolin (Novo Nordisk)

• GLP-1 agonists

  • Adlyxin (Sanofi)

  • Bydureon (AstraZeneca)

  • Ozempic (Novo Nordisk)

  • Rybelsus (Novo Nordisk)

  • Trulicity (Lilly)

  • Victoza (Novo Nordisk)

• SGLT-2 inhibitors

  • Farxiga (AstraZeneca)

  • Invokana (Johnson & Johnson)

  • Jardiance (BI)

• DPP-4 inhibitors

  • Januvia (Merck)

  • Nesina (Takeda)

  • Onglyza & Kombiglyze (AstraZeneca)

  • Tradjenta (BI)

• Glucagon

  • Baqsimi (Lilly)

  • Glucagon (Lilly)

  • GlucaGen HypoKit (Novo Nordisk)

• Combination drugs

  • Glyxambi (BI)

  • Invokamet (J&J)

  • Janumet (Merck)

  • Qtern (AstraZeneca)

  • Soliqua (Sanofi)

  • Synjardy (BI) 

  • Xigduo (AstraZeneca)

  • Xultophy (Novo Nordisk)

• Pramlintide

  • Symlin (AstraZeneca)

Assistance is available for:

• Onglyza and Kombiglyze

• Bydureon and Byetta

• Farxiga

• Qtern

• Symlin

• Xigduo

Website: AstraZeneca’s AZ&Me Prescription Savings Program

Phone number: 1-800-292-6363

Cost: Free

Eligibility:

Take this easy quiz to quickly determine eligibility.

• Must be a resident of the US.

• Must not have prescription drug coverage through private insurance or government insurance (excluding Medicare).

• If enrolled in Medicare Part D:

  • Must have spent at least 3% of household income on prescription medications since the start of the calendar year at time of application

  • Must not be eligible for or enrolled in Low Income Subsidy (LIS)

• Total household income must be at or below $36,420 for an individual, $49,380 for a couple, and $75,300 for a family of four.

How to apply:

• Click here for the application, which must be completed by the applicant and healthcare professional and either mailed or faxed.

• You will need proof of income (two current pay stubs, copy of last year's Federal Income Tax Return, copy of W-2, etc.), Medicaid or Low Income Subsidy denial (if applicable), photocopy documentation of prescription medicine spending (if applicable). You can write in either your monthly or yearly income.

• If you are on Medicare, you will also need to provide a copy of your Medicare Part B or Part D Prescription Drug Plan statement (Explanation of Benefits-EOB) and documentation (receipts, etc.) of how much you've spent on prescription medicine in the current calendar year. 

• If you’ve experienced a life-changing event such as job loss, income change, loss of prescription drug coverage, marriage, or change in household number that isn’t reflected in current documentation at the time of application, you are still encouraged to apply. 

What to expect if your application is approved:

• Application approval may last for up to a year, and AstraZenca will send an application for renewal once enrollment ends.

• Expect repeated shipments of up to a 90-day supply for the duration of enrollment (prescriber must put in the re-order request every three months).

• For prescription refills and other questions, call 1-800-292-6363.

diaTribe’s observations about the application:

• The application’s length is mainly due to its large, easy-to-read font – don’t let that deter you!

• Fairly lengthy: Set aside 10-15 minutes to read and fill out the patient portion of the application.

Assistance is available for:

• Glyxambi

• Jardiance

• Synjardy

• Tradjenta

Website: Boehringer-Ingelheim Cares Foundation Patient Assistance Program

Phone number: 1-800-556-8317, representatives are available Monday through Friday, 7:30 am to 5:00 pm central time

Cost: Free

Eligibility:

• Must be a resident with a physical address in the US.

• Must either have no health insurance or not enough coverage to pay for the medication (meaning you cannot afford the out-of-pocket expense).

• Must meet income requirements (not defined publicly). 

How to apply:

• Click here for an editable form version of the application and here for a flat form (to print and fill out), which must be completed by the applicant and healthcare professional and either mailed or faxed.

What to expect if your application is approved:

• Expect repeated shipments of up to a 90-day supply for the duration of enrollment (your prescriber must provide a prescription with enough refills). Refills can be requested via phone call to the customer service phone line. Reminders to refill prescriptions are also placed to enrolled participants that opt-in for phone notifications. 

• No proof of income needed.

• You can reapply in January of the next year.

diaTribe’s observations about the application:

• This application requires you to report your total household income for the year and to estimate “total household assets.” Check out this article explaining what household assets are.

• Short length: Set aside 5-7 minutes to read and fill out the patient portion of

Assistance is available for:

• Invokana

• Invokamet

Website: J&J Patient Assistance Foundation

Phone number: 1-800-652-6227

Cost: free

Eligibility:

Take this easy quiz to quickly determine eligibility

• Must live in the US or a US Territory.

• Must not have private insurance or prescription coverage

• If you are enrolled in Medicare Part D and need financial assistance, ask your pharmacy for a report on out-of-pocket costs for the year. You must have spent at least 4% of your annual income on prescription medications to qualify for assistance. Submit this report or an Explanation of Benefits (EOB) with your application.

• Household income must be at or below $38,280 for an individual, $51,720 for a couple, and $78,600 for a family of four (see this page for more details).

How to apply:

• Click here for the application, which must be completed by the applicant and healthcare professional and mailed or faxed

• Submit your application with your most recent federal income tax return (1040 or 1040EZ).

What to expect if your application is approved:

• Up to one-year supply of medication.

• You can reapply annually and will receive a reminder to do so.

diaTribe’s observations about the application:

• This application is more straightforward than others.

• Medium length: set aside 7-10 minutes to fill out this application.

Assistance is available for:

• Baqsimi

• Basaglar

• Humalog U100, U200

• Humalog Mix 75/25, Humalog Mix 50/50

• Humulin 70/30, Humulin N, Humulin R, Humulin R U-500

• Glucagon

• Trulicity

Website: Lilly Cares program

Phone number: 1-800-545-6962

Cost: Free

Eligibility:

• Must be a resident of the US or Puerto Rico.

• Must have no health insurance, have Medicare Part D, or no coverage for the Lilly medication. 

• Must not be enrolled in Medicaid, Low Income Subsidy, or VA Benefits. 

• Household income must be at or under $51,040 for an individual, $68,960 for a couple, or $104,800 for a family of four (see this page for more income requirements). These amounts are equal to four times (400%) of the Federal Poverty Level (FPL). 

How to apply:

• Click here for the application, which must be filled out by the applicant and healthcare professional and be mailed or faxed.

• You must provide a copy of proof of income (pay stubs, copy of Federal Income Tax Return, copy of W-2, or Social Security Benefit Statement).

• Bring your proof of income (and other documents, if necessary) and application to your doctor, who must fill out the Health Care Practitioner section.

Tip: Sign up for a text message alert to be notified that your application is approved.

What to expect if your application is approved:

• Repeated up to a 120-day (4-month) supply for up to one year.

• You will be enrolled in the program for 12 months. If you have Medicare Part D, you will be enrolled in the program until the end of the calendar year. 

• Your healthcare professional can use this form to order refills.

• You can reapply every year.

diaTribe’s observations about the application:

• This application has some of the most complicated eligibility requirements. 

• Long length: set aside 10-15 minutes to read and fill out the patient portion of the application.

Learn more about Lilly’s drug pricing:

If interested, learn more about how Lilly prices their drugs at lillypricinginfo.com, or by calling (800) 545-5979. 

Assistance is available for:

• Januvia

• Janumet

Website: Merck Helps

Phone number: 1-800-727-5400

Cost: Free

Eligibility:

• Check your eligibility online here for Januvia and here for Janumet. 

• Must be a US resident. 

• Must not have insurance or other prescription medicine coverage, including private insurance, HMOs, Medicaid, Medicare, and other assistance programs. 

• Household income must be at or less than $51,040 for an individual, $68,960 for a couple, or $104,800 for a family of four. These amounts are equal to four times (400%) the Federal Poverty Level (FPL). 

How to apply: ​

• Click here for the application for Januvia or Janumet and here for the application in Spanish. You can either fill out the application online and print it or print it and fill it out by hand. 

• No proof of income needed.

• The application should be completed by both the person with diabetes and his or her healthcare professional, and then mailed to Merck

What to expect if your application is approved:

• You will receive up to a 90-day supply up to 3 times per year, which will be shipped either to your home or doctor's office for pickup. 

• You can reapply every year.

diaTribe observations about the application:

• Short length: set aside 5 minutes to read and fill out the patient portion of the application

Assistance is available for:

• Fiasp

• Levemir

• GlucaGen Hypo Kit

• Novolin

• NovoLog, NovoLog Mix 70/30

• Ozempic

• Rybelsus

• Tresiba

• Victoza

• Xultophy

Website: Novo Nordisk’s Diabetes Care Patient Assistance Program

Phone number: 1-866-310-7549

Cost: Free

Eligibility:

• Must be a US citizen or resident.

• Must be uninsured or have Medicare.

• Must not be enrolled in or qualify for any other federal, state, or government programs such as Medicaid, Veteran Affairs (VA) Benefits, or Low Income Subsidy (LIS).

• Exceptions include those eligible for Medicaid, who have applied for and been denied Medicaid.

• Household income must be at or less than $51,040 for an individual, $68,960 for a couple, or $104,800 for a family of four. These amounts are equal to four times (400%) the Federal Poverty Level (FPL). 

How to apply:

• Click here for the application in English and here for the application in Spanish.

• You will need a copy of proof of income (two pay stubs or earning statements for all working members of your household, last year's copy of Federal Income Tax Return, copy of W-2, etc.), Medicaid or Low Income Subsidy denial (if applicable).

• Bring a copy of your proof of income (and other documents, if necessary) and application to your doctor, who must fill out the Health Care Practitioner section.

What to expect if your application is approved:

• You will receive up to a 120-day supply, sent to prescribing healthcare professional’s office for pickup.

• You will be enrolled in the program for 12 months. If you have Medicare Part D, you will be enrolled in the program until the end of the calendar year. 

• Refills will be coordinated between Novo Nordisk and your healthcare professional.

• You will need to request Novo Nordisk disposable needles for insulin pens in order to receive them. 

Tip: To apply for Low Income Subsidy, contact the Social Security Administration at 800-772-1213 or go to www.socialsecurity.gov/prescriptionhelp/.

diaTribe observations about the application:

• Medium length: set aside 10 minutes to read and fill out the patient portion of the application.

• Novo Nordisk will conveniently give you an automated call notifying you of your application’s status.

Assistance is available for:

• Adlyxin

• Admelog

• Apidra

• Lantus

• Soliqua 100/33

• Toujeo U300

Website: Sanofi’s Patient Assistance Connection

Phone number: 1-888-847-4877

Cost: Free

Eligibility:

• Must be a resident of the US or US territories.

• Must not have insurance, or existing insurance doesn’t cover Lantus.

• Must not be eligible for Medicaid, or must provide proof of Medicaid denial to be assessed for the program.

• If enrolled in Medicare Part D, out-of-pocket drug expenses must reach at least 2% of your annual household income in the current calendar year. 

• ​Household income must be at or less than $51,040 for an individual, $68,960 for a couple, or $104,800 for a family of four. These amounts are equal to four times (400%) the Federal Poverty Level (FPL). 

How to apply:

• Click here for the application, which you and your healthcare professional should complete, and then your doctor will mail or fax your application to Sanofi. 

• No proof of income needed (income verified via soft credit inquiry)

What to expect if your application is approved:

• If you are enrolled or denied, you and your healthcare professional will receive a letter. 

• Repeated shipments of a 90-day supply will be sent to your healthcare professional's office for the duration of your enrollment in the program. Your prescriber must put in the re-order request every three months. 

• You will be enrolled in the program for 12 months. If you have Medicare Part D, you will be enrolled in the program until the end of the calendar year. 

diaTribe observations about the application:

• Short length: set aside 5-7 minutes to read and fill out the patient portion of the application

Assistance is available for:

• Nesina

Website: Takeda’s Help at Hand Program

Phone number: 1-800-830-9159

Cost: Free

Eligibility:

• Must be a resident in the US. 

• Must have no insurance or not enough coverage to afford Nesina.

• Household income must be at or below five times the Federal Poverty Level, which is $63,800 for an individual, $86,200 for a couple, or $131,000 for a household of four.

How to apply:

• Click here to print out the application, fill it out with your healthcare professional, and then mail or fax the application to Tadeka. 

• You will need a copy of your proof of income (all household income statements from the last month, last year's Federal Income Tax Return, or your Social Security Yearly Benefits Statement).

diaTribe’s observations about the application:

• Short length: set aside 5-7 minutes to read and fill out the patient portion of the application.

Below is information provided by diabetes drug manufacturers covered in this article about the amount invested in each patient assistance program.

AstraZeneca has not yet provided any comment to our inquiry.

The Boehringer Ingelheim Cares Foundation Patient Assistance Program makes Boehringer Ingelheim medicines available free of charge to eligible patients. People can learn more about the program here. Since the Foundation was founded in 2001, it has donated over $2.2 billion in medicines through its Patient Assistance and Product Donation Programs. In 2017, the Patient Assistance Program helped approximately 50,000 patients in need through over 130,000 shipments. Diabetes medicines represent nearly 25% of the medicines dispensed.

Johnson & Johnson donates medicines and funding to the Johnson & Johnson Patient Assistance Foundation, Inc., an independent, nonprofit organization that provides Janssen medicines to U.S. patients who do not have insurance coverage for these products and do not have adequate financial resources. More information about the Johnson & Johnson Patient Assistance Foundation is available at www.jjpaf.org.

Johnson & Johnson donated medicines valued at approximately $620 million to support 2016 operations of the Johnson & Johnson Patient Assistance Foundation, enabling the Foundation to provide medicines at no cost to approximately 75,000 patients.

Eli Lilly and Company donated $685 million in free medicines in 2016 in the United States, most of which were donated to the Lilly Cares Foundation, a section 501(c)(3) organization that provides free medicines to qualifying patients.

The Lilly Cares Foundation Patient Assistance Program, a nonprofit organization, supported 111,000 patients in calendar year 2016. The largest patient populations served were mental health followed by diabetes. The Lilly Cares Foundation provided free Lilly products to 42,000 insulin-taking patients in 2016.

In 2016, Merck dispensed 1.7 million 30-day prescriptions valued at $798 million for 306,000 patients in the U.S. Patient Assistance Program.

Novo Nordisk was unable to share any information.

Sanofi: the below relates to the period of 2014 - 2016 and covers all Sanofi diabetes products that were available during this time period:

• 378,761 diabetes patients assisted either through the PAP (free drug) program or were provided assistance with their insurance coverage

• 596,818 diabetes PAP (free drug) orders were distributed

Takeda has not yet provided any comment to our inquiry.

Special thanks to Elizaveta Maslak and Ben Ose for contributing to this article.