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Gout Travel Fund

Status

Open (Accepting phone applications only)

Fund Type

Copay

Maximum Award Level

$2,500

Pharmacy Card Fund

No

Minimum Copay Reimbursement Amount

$5

Household Income Limit

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

Treatments Covered

  • Aceclofenac
  • Acemetacin
  • Allopurinol
  • Amtolmetin Guacil
  • Apazone
  • Bufexamac
  • Celecoxib
  • Clonixin
  • Colchicine
  • Colcrys
  • Cortisone
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac Potassium
  • Diclofenac Sodium
  • Diflunisal
  • Dipyrone
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Febuxostat
  • Felbinac
  • Fenbufen
  • Fenofibrate
  • Fenoprofen
  • Floctafenine
  • Flufenamic Acid
  • Flurbiprofen
  • Hydrocortisone
  • Indomethacin
  • Ketoprofen
  • Ketorolac
  • Krystexxa
  • Lodging
  • Lopurin
  • Lornoxicam
  • Losartan
  • Losartan Potassium
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Meclofernamate Sodium
  • Mefenamic Acid
  • Meloxicam
  • Methylprednisolone
  • Morniflumate
  • Nabumetone
  • Niflumic Acid
  • Nimesulide
  • Oxaprozin
  • Parecoxib
  • Pegloticase
  • Piketoprofen
  • Piroxicam
  • Prednisolone
  • Prednisone
  • Proglumetacin
  • Propyphenazone
  • Proquazone
  • Salicylic Acid
  • Salsalate
  • Sodium Salicylate
  • Sodium Thiosalicylate
  • Sulindac
  • Tenoxicam
  • Tiaprofenic Acid
  • Tolmetin
  • Transportation - Air
  • Transportation - Bus
  • Transportation - Car Mileage
  • Transportation - Taxi
  • Transportation - Train
  • Triamcinolone
  • Uloric
  • Zurampic
  • Zyloprim

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 Gout and travel to receive treatment.

    Through the Gout Travel Fund, we are able to assist with eligible transportation costs related to receiving treatment. You will be asked to provide the Foundation with your diagnosis, which must be verified by a physician, nurse practitioner, or physician assistant’s signature. Please note, the following guidelines must be met in order for the HealthWell Foundation to consider reimbursement:

    Transportation Reimbursement:
    If you or a family member/friend drive: Driving distance between your residence and drug distribution site (pharmacy or infusion center) or blood monitoring lab site must be at least 25 miles (50 miles roundtrip), based on the most direct route. Please note, car mileage will be reimbursed at the IRS Standard Business Mileage rate, and parking fees will be reimbursed with submission of receipts.

    If you use public transportation or hire a taxi: Transportation costs incurred must be at least $10.00 one way ($20.00 roundtrip), based on the most direct route. For example, if you use a taxi to get to the drug distribution site (pharmacy or infusion center) or blood monitoring lab site, the costs incurred must be at least $20.00 roundtrip

    Proof of Date of Service is required if you do not have a current Gout copay grant with HealthWell Foundation. An associated Date of Service payment must be processed if the patient has a current Gout copay grant with HealthWell Foundation.

    Lodging Reimbursement: Driving distance between your residence and drug distribution site must be at least 100 miles (200 miles roundtrip), based on the most direct route.

    Hotel room costs will be reimbursed up to $100.00 a night per infusion with submission of receipt.

    Proof of Date of Service is required if patient does not have a current Gout copay grant with HealthWell Foundation. An associated Date of Service payment must be processed if the patient has a current Gout copay grant with HealthWell Foundation.

  • 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, please call (800) 675-8416 to speak with a HealthWell representative.
  • 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 Gout

Through the Gout Travel Fund, we are able to assist with eligible transportation costs related to receiving treatment. Gout is a painful and potentially disabling form of arthritis. Gout occurs when excess uric acid (a normal waste product) collects in the body, and needle‐like urate crystals deposit in the joints. This may happen because either uric acid production increases or, more often, the kidneys cannot remove uric acid from the body well enough. Source: American College of Rheumatology

Additional Resources

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