Welcome to the HealthWell Foundation – we look forward to working with specialty and retail pharmacists, pharmacy staff, and advocates to help patients start and continue their therapies. We value your efforts and all you do for our grant recipients!
Below are some common questions we receive from our pharmacy partners. If you need addition clarification or have a question not included below, please call our hotline at 800-675-8416.
Frequently Asked Questions
HealthWell is a copayment assistance foundation. We help patients who have insurance, but still cannot afford their out-of-pocket expenses related to treatment. We can help with insurance copays, coinsurances, and deductibles. In some cases, we can help with insurance premiums.
We are set up by disease fund and patients we help must fall into one of our open funds. If you have a patient who needs assistance in a fund we do not have open, you or your patient can call our hotline and ask for a referral to another copayment assistance foundation or other resource. We will do our best to get the patient someplace that can help.
The remaining criteria are straight forward:
- The patient’s annual household income can be up to 400 or 500 percent of the Federal Poverty Level. We do adjust for household size and high cost of living areas. As a rough estimate, a single person with an income of approximately $44,600 or a family of four with a household income of approximately $92,000 could qualify.
- Patients must have insurance coverage for the medications they need assistance with so if they need help with Product ABC, but their insurance does not cover Product ABC at all, they will not qualify.
- The treatment must be dispensed in the United States.
Yes! You can apply on behalf of a patient as long as you have their consent to do so. The easiest and fastest way to apply is to use the Provider Portal or Pharmacy Portal. Follow the prompts and answer all required fields.
Some patients will receive a HealthWell Pharmacy Card with their approval letter. Please see the Pharmacy Card page for additional information.
For patients without a HealthWell Pharmacy Card, reimbursement will be handled through the reimbursement request process. Please see the Get Reimbursed page for additional information.
Some patients may receive a HealthWell Pharmacy Card in their approval letter. If your patient has not yet received the Pharmacy Card, but they have been approved, you can get the needed information using our Pharmacy Card Look Up Tool.
For patients with a HealthWell Pharmacy Card, you would run the claim through ALL OTHER INSURANCES FIRST, then run the claim using the HealthWell Pharmacy Card. All payments are handled electronically, if you have any technical questions or concerns, you can call the Pharmacy Card Helpdesk at (855) 326-9533.
HealthWell is the payer of last resort and we require the Coordination of Benefits (COB) code 8 to ensure the patient’s grant is accessed appropriately. As all our grants are capped, once that capped amount is reached, the patient cannot get more money until they re-enroll for the next calendar year. By running the HealthWell card first, you run the risk of burning through the patient’s grant prematurely. Without our assistance, the patient may have to stop therapy altogether.
For patients who do not receive a HealthWell Pharmacy Card, you have the option of direct billing with HealthWell. This is helpful for many patients who cannot pay up front and wait for reimbursement. To direct bill with us, you simply complete a and submit it with the documentation as outlined on the form.
In order for patient grants to remain active, we must receive the first complete reimbursement request within 120 days of the date on their approval letter, and continue to receive a complete reimbursement request at least every 120 days. After 120 days of inactivity on the grant (i.e., no payment activity), the grant will close. If the grant closes, you may still submit eligible payments requests, however, we cannot guarantee funding will be available and payment made.
HealthWell kindly asks that payment requests be submitted to us within 120 days from the date of service. After 120 days, HealthWell will consider payment on a case-by-case basis depending on circumstances relative to the delay.