Breakthrough Cancer Pain - Medicare Access (Medicare patients only)



Fund Type


Maximum Award Level


Pharmacy Card Fund


Household Income Limit

500% of the Federal Poverty Level
(adjusted for household size and high
cost of living areas)

Fund Alerts

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Treatments Covered

  • Abstral
  • Actiq
  • Duragesic
  • Fentanyl Ot
  • Fentanyl Transdermal System
  • Fentora
  • Ionsys
  • Lazanda
  • Onsolis
  • Oral Transmucosal Fentanyl Citrate
  • Subsys

Fund Definition

Assistance with the prescription drugs and biologics used in the treatment and management of breakthrough cancer pain.

Grant Utilization

HealthWell estimates that patients use an average of $3,500 during their 12-month grant period for this disease area.

Consider Premium Assistance

Under this fund, HealthWell can assist with premium costs. Medicare supplemental policies can help with cost shares related to many aspects of your health care. Using a HealthWell grant to cover premiums may be a better option than treatment-specific cost shares.

Do I Qualify?

HealthWell bases eligibility on an individual’s medical, financial and insurance situation. To qualify for HealthWell’s assistance, applicants must meet the following eligibility requirements:

  • Please make sure that HealthWell currently has a fund for your diagnosis/indication and that your medication is covered under that fund by visiting our Disease Funds listing. If we do not have a fund that currently covers your diagnosis, please check back as we frequently open and reopen programs as funding becomes available. The Foundation is able to help patients receiving treatment for indications for which we currently have an open fund. We can only assist with medications that have been prescribed to treat the disease/covered diagnosis. You will be asked to provide the Foundation with the patient’s diagnosis, which must be verified by a physician, nurse practitioner, or physician assistant’s signature. The patient must receive treatment in the United States.

  • This is a Medicare Access Fund. In order to qualify for assistance through this fund, you must have Medicare. The Foundation will refer patients without Medicare to other programs, such as manufacturer patient assistance programs.

  • HealthWell assists individuals with incomes up to 300-500% of the Federal Poverty Level. The Foundation also considers the number in a household and cost of living in a particular city or state.
  • If you are receiving treatment in the U.S. and have met the eligibility criteria as listed, you are ready to apply! Please note that you will be asked to provide a Social Security Number in order to create a grant. This information is gathered to eliminate duplicate applications and is kept secure and confidential.

Because of the sensitivity around the products covered under this fund, we require the provider or pharmacy to please submit applications online through our Provider or Pharmacy portal. Patients, family members or friends cannot enroll the patient for assistance under the fund.

Upon submission of the portal application, we will require the prescriber to complete and submit a Breakthrough Cancer Pain Statement available on our website. A completed Statement must be received for each patient enrolled no later than 30 days from the grant approval date. HealthWell reserves the right to deactivate any pharmacy card or hold processing on paper claim submissions for any grant where the Statement has not been submitted.



About Breakthrough Cancer Pain

According to the American Cancer Society, breakthrough pain is a flare of pain that happens even though a person is taking pain medicine regularly for chronic pain. It is called breakthrough pain because it “breaks through” the pain relief provided by regular pain medicine. Breakthrough pain is not controlled by regular doses of pain medicines, varies in intensity, and usually cannot be predicted. As a rule, it comes on quickly, lasts as long as an hour, and feels much like chronic pain except that it’s worse – more severe or intense. It can happen many times a day, even when the chronic pain is controlled by regular pain medicine. Breakthrough pain often has the same cause as chronic pain; it may be the cancer itself or it may be related to cancer treatment. Source: American Cancer Society


Additional Resources

You may also visit our Resource List to view other copayment organizations that may provide assistance.

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