We are currently experiencing significant increases in the number of payment inquiries in our queue. This increase is partly due to duplicate submissions for the same request, which has contributed to longer processing times and delays in responding to inquiries. To help streamline processing and ensure timely support, we kindly ask that you submit one request through your dedicated provider or pharmacy portal.
Thank you for your patience as we work diligently to address all inquiries in the order in which they were received as quickly as possible.
The HealthWell Team
Status
Closed
Closed Funds
This fund is temporarily closed to new patients due to lack of sufficient funding. Please continue to visit our Disease Funds page often, as replenished funds reopen as quickly as possible. If you currently have a grant with HealthWell, your grant will remain active for the entire 12 month grant cycle or until you have exhausted your allocated grant amount, whichever comes first. You can continue to use your pharmacy card or submit requests for reimbursements during your designated grant cycle.
Assistance Type
Prescription Drug Copay
Maximum Award Level
$2,500
Payment Type
Pharmacy Card
Minimum Copay Reimbursement Amount
Minimum Copay Reimbursement Amount
We encourage you to please use your HealthWell pharmacy card for any applicable charges as possible.
None
Minimum Premium Reimbursement Amount
Minimum Premium Reimbursement Amount
We encourage you to please submit monthly reimbursement claims (even if your premium is paid on a bi-weekly basis).
Insulin Human Regular/insulin Human Isophane (nph)*
Insulin Lispro
Insulin Lispro Junior Kwikpen
Insulin Lispro Kwikpen
Insulin Lispro Protamine/ins Lispro 75/25 Kwikpen
Insulin Lispro/insulin Lispro Protamine
Jardiance
Lantus
Lantus Solostar Pen
Levemir
Levemir Flexpen
Liraglutide
Lyumjev Kwikpen U-100
Lyumjev Kwikpen U-200
Lyumjev Tempo Pen
Lyumjev U-100
Metformin Hcl
Metformin Hcl Avpak
Metformin Hydrochloride
Metformin/dapagliflozin
Metformin/empagliflozin
Myxredlin
Novolin 70/30
Novolin 70/30 Flexpen
Novolin N (nph)
Novolin N Flexpen
Novolin R
Novolin R Flexpen
Novolog
Novolog Flexpen
Novolog Mix 70/30
Novolog Mix 70/30 Flexpen
Omnipod
Precose
Relion Novolin 70/30
Relion Novolin 70/30 Flexpen
Relion Novolin N Flexpen
Relion Novolin R
Relion Novolin R Flexpen
Relion Novolog
Relion Novolog Flexpen
Relion Novolog Mix 70/30
Relion Novolog Mix 70/30 Flexpen
Rezvoglar Kwikpen
Riomet
Riomet Er
Saxenda
Semglee
Semglee Pen
Synjardy
Synjardy Xr
Toujeo 1.5ml Prefilled Pen
Toujeo Max 3ml Prefilled Pen
Tresiba
Tresiba Flextouch Pen
Trulicity
Tzield
Victoza
Xigduo Xr
Zegalogue
*These products are not billable through HealthWell’s pharmacy card. Please submit requests for reimbursement through our paper claim process.
Fund Definition
Assistance with the cost shares of prescription drugs, therapies, devices, and transportation related to eligible disease states (Acute Lymphoid Leukemia, Autism Spectrum Disorder (including ADD and ADHD), Congenital Heart Disease, Convergence Insufficiency, Diabetes (Types I and II).
Grant Utilization
HealthWell estimates that patients use an average of $1,500 during their 12-month grant period for this disease area.
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:
To find out if you are eligible for HealthWell’s Pediatric Assistance Fund, please contact us at (800) 675-8416 to speak with a HealthWell representative or apply online. We can only assist with medications that have been prescribed to treat the disease/disorder 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.
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.
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 believe you qualify for assistance, please call (800) 675-8416 to speak with a HealthWell representative.
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.
To apply for a grant through our Pediatric Assistance Fund, you can contact a HealthWell representative at 1-800-675-8416 or apply online. We wish we could say “yes” to every family that comes to us, however, funding is limited. Families must meet HealthWell’s standard income and insurance eligibility criteria to qualify for a grant. Grants are awarded through the Pediatric Assistance Fund. To apply for a grant, call 1-800-675-8416 anytime Monday through Friday, 9:00 a.m. to 5:00 p.m. (ET).
About HealthWell’s Pediatric Assistance Fund
HealthWell’s Pediatric Assistance Fund helps children access the medical treatments they need for specific diseases or conditions. Through the fund, HealthWell is able to assist families in meeting their cost-sharing obligations for conditions covered under the fund to help their child start or continue treatments they otherwise would not be able to afford.
You may also visit our Resource List to view other copayment organizations that may provide assistance.
