Attention: The HealthWell Foundation has changed its P.O. Box! Our new address is: P.O. Box 489, Buckeystown, MD 21717. Please update your records now to avoid future delays in processing.
For immediate receipt, upload your documents thru HealthWell’s Pharmacy and Provider portals. You may also fax your documents to us at 800-282-7692.
Dismiss alert

Diabetic Foot Ulcers

Status

Closed

Fund Type

Copay/Premium

Maximum Award Level

$1,500

Pharmacy Card Fund

Yes

Household Income Limit

400% of the Federal Poverty Level
(adjusted for household size and high cost of living areas)

Treatments Covered

  • Active Wound Care Management
  • Alginate Dressing Greater Than 16 But Less Than 48 Square Inches
  • Ampicillin
  • Apligraf, Per Square Centimeter
  • Azactam
  • Aztreonam
  • Becaplermin
  • Cayston
  • Cilastatin
  • Cipro
  • Cipro Iv
  • Ciprofloxacin
  • Collagen Dressing 16sq Inches Or Less
  • Collagenase
  • Debridement Of Nails, Muscle Or With Anesthesia
  • Epifix
  • Epifix, Per Square Centimeter
  • Ertapenem
  • Flagyl
  • Foot Radiology Exam 2 View
  • Gauze Soaked W/other Than Water
  • Hyalomatrix
  • Hyaluronic Acid
  • Hyaluronic Acid Sodium Salt
  • Hydrolyzed Hyaluronic Acid
  • Hymovis
  • Imipenem
  • Invanz
  • Levaquin
  • Levofloxacin
  • Linezolid
  • Metrogel
  • Metrogream
  • Metrolotion
  • Metronidazole
  • Monovisc
  • Novaplus Aztreonam
  • Novaplus Ciprofloaxin
  • Novaplus Imipenem
  • Novaplus Piperacillin Sodium
  • Novaplus Zosyn
  • Novaplus Zyvox
  • Orthovisc
  • Piperacillin
  • Premierpro Rx Aztreonam
  • Premierpro Rx Piperacillin
  • Premierpro Rx Tazobactam
  • Premierpro Rx Zosyn
  • Premierpro Rx Zyvox
  • Primaxin Iv
  • Puraply
  • Regranex
  • Routine Venipuncture
  • Santyl
  • Skin Replacement Surgery
  • Sodium Hyaluronate
  • Sulbactam
  • Surgical Prep Or Creation Of Recipient, Site Tissue Skin Graft
  • Tazobactam
  • Unasyn
  • Under Skin Substitute Grafts
  • Zyvox

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:

  • 1.You are being treated for Diabetic Foot Ulcers.

    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.

  • 2.You have insurance and it covers your medication.

    To qualify for assistance from HealthWell, you must have some form of health insurance (private insurance, Medicare, Medicaid, TriCare, etc.) that covers part of the cost of your treatment. The Foundation will refer patients without prescription insurance to other programs, such as manufacturer patient assistance programs.

  • 3.Your income falls within our guidelines.
    HealthWell assists individuals with incomes up to 400-500% 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 believe you qualify for assistance, you may begin the application process here.
  • 4.You are receiving treatment in the United States.

    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.

 

About Diabetic Foot Ulcers

According to the American Podiatric Medical Association (APMA), a diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication. Between 14-24 percent of diabetes patients with foot ulcers will require an amputation. Source:American Podiatric Medical Association

Additional Resources

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