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Getting Started

  • Once a patient is approved, we begin reimbursing for dates of service and prescription fill dates that fall within the enrollment period.
  • Patients will receive a HealthWell Pharmacy Card and a Reimbursement Request Form.
  • If the pharmacy can use the HealthWell Pharmacy Card for a prescription fill, there is no need to submit a Reimbursement Request Form.
  • You may need to verify the patient’s diagnosis in order to continue receiving payments after the first one is made. You’ll find Diagnosis Verification Forms here.

Using Your HealthWell Pharmacy Card

  • Before submitting your HealthWell Pharmacy Card for payment, make sure the pharmacist runs all applicable INSURANCE and PRESCRIPTION cards, and any applicable MANUFACTURER coupon or discount cards first.
  • To use the card, simply provide the billing information on the pharmacy card at any specialty, retail or mail order pharmacy.
  • You must use the HealthWell Pharmacy Card regularly to keep your grant active. Please make sure to use your card at least once every four months.
  • If you can’t find your card, you can look up your card number here.

Using Reimbursement Request Forms

  • Use a reimbursement form in cases where you cannot use your pharmacy card. Forms are available here.
  • For most HealthWell funds, the minimum reimbursement is $5. However, you may combine reimbursement requests and if the total exceeds $5, the combined amount may be eligible for reimbursement.
  • For premium assistance, HealthWell prefers to pay your insurer directly, and we can only reimburse on one insurance policy’s premium at a time.

Copay Reimbursement Request Forms


Premium Reimbursement Request Forms

Important Guidelines, Practices and Forms

  • Always run each claim through all other insurance, prescription cards and manufacturer programs before using your HealthWell Pharmacy card.
  • Remember, HealthWell will only process payment requests at or above the fund’s minimum reimbursement amount.
  • Be mindful of the 120-day rule and submit timely reimbursement requests:
    • After 120 days of inactivity on your grant — meaning no payment activity through your card or reimbursement forms — your grant will be closed.
    • Given that, we must receive your first reimbursement request within 120 days of your approval.
    • If a grant closes, the patient, provider or pharmacist may still submit eligible payment requests, but we cannot guarantee funding.
    • We ask that payment requests be submitted within 120 days from the date of service. After 120 days, HealthWell will consider payment on a case-by-case basis depending on circumstances related to the delay.
  • Once we receive a complete payable reimbursement request, you should receive a reimbursement check in approximately two weeks.
  • A patient may change assistance type — that is, switch from copay to premium assistance or premium to copay assistance — one time during his/her enrollment period.
  • As an added note, all patients who have been approved for a grant are subject to an income documents review. During the review process, the patient’s grant will be temporarily inactive until his/her income has been verified. Download the required Income Verification Statement below.