Frequently Asked Questions
You can send questions to the HealthWell team via email at email@example.com or you can call the HealthWell hotline at (800) 675-8416 from 9:00 a.m. to 5:00 p.m., Monday through Friday, Eastern Time (closed on major holidays).
If you are ready to apply on behalf of a patient, you can do so online at your convenience.
HealthWell provides financial assistance to eligible individuals to cover coinsurance, copayments, health care premiums and deductibles for certain treatments. This means that if your patient is prescribed a medication and the insurer covers it, but the patient cannot afford the coinsurance or copayment required, we may be able to help by paying some or all of the patient’s costs associated with the medication. Also, if the patient is eligible for health insurance, but cannot afford the insurance premium, we may be able to help by paying some or all of the insurance premium.
HealthWell may approve patients for assistance with insurance premiums for one fund and copayments for a second fund, but never both types of assistance under one fund.
At this time, HealthWell is able to help patients taking treatments only for selected diseases. For an updated listing of diseases, see our Disease and Medications page. HealthWell adds new disease funds throughout the year, so please visit this site regularly for the latest information.
To qualify for assistance, patients must meet HealthWell’s insurance, income, and medical criteria. With your patient’s permission, you can apply on his or her behalf through the Provider Portal or Pharmacy Portal.
Eligibility criteria include: household income up to 400 or 500 percent of the Federal Poverty Level (somewhat more in cities where the cost of living is higher); the patient is being treated for a specific disease for which funding is available; the patient has insurance that covers the treatment for this disease; and the medication is dispensed in the U.S.
HealthWell assists uninsured patients who need help paying for their insurance premiums. If a patient is eligible for an insurance plan that would pay for treatments, but is having trouble affording the premium, HealthWell may be able to help.
HealthWell cannot assist uninsured patients who need help paying the full cost of their treatment. However, HealthWell can refer anyone to other resources that may be helpful, such as drug manufacturers’ patient assistance programs and state prescription assistance programs. See our resources page for more helpful links.
HealthWell is a charity designed to help patients start and continue therapy. We have caps on all of our grants that are set to help the majority of our patients with a full 12 months of therapy assistance. We strongly encourage patients to manage their grant wisely and plan ahead for any months where they may still be on therapy but their assistance through HealthWell is exhausted.
HSAs and HRAs are not traditional insurances. For patients with an HSA or HRA account, consideration is based on who contributes and how often the account is replenished during the year. Requests are reviewed on a case by case basis.
As long as patients meet all eligibility requirements, we do not require them to exhaust their Flexible Spending Accounts (FSA) before submitting a claim under any grant. However, HealthWell will not pay or reimburse any claim for any service or cost already reimbursed under an FSA. Further, any claim paid or reimbursed by HealthWell cannot also be submitted to a FSA for payment or reimbursement.
After approval via phone or online, we will send the patient an approval letter and fax a copy to you as long as you provide us with your fax number. The approval letter will include the enrollment period dates and grant amount. For some funds, we provide patients with a HealthWell Pharmacy Card for electronic point-of-sale processing; for other funds, the approval letter will include a depending on the type of assistance requested. The Reimbursement Request Form includes full instructions on how to submit for reimbursement.
- What happens if I change my patient’s prescription during the enrollment year? Does that change the award amount of the grant?
As long as you are prescribing an eligible therapy for the disease fund in which the patient is enrolled, it will not affect their eligibility or grant award amount. Patients are free to change their treatment, physician, or pharmacy at any time and it will not affect their eligibility for assistance or change the amount of their award.
HealthWell pays only copayments related to prescription or biologic treatments covered under the fund and prescribed specifically for the medical condition listed in the patient’s application.
Each grant has a maximum award amount and caps vary by fund. The fund profiles provide the cap amount of each fund.
HealthWell operates on a rolling 12-month grant cycle; all grant enrollments cover a 12-month period. Re-enrollment can be completed through our Provider Portal or Pharmacy Portal. Please remember that HealthWell grants assistance on a first-come, first-served basis to the extent funding is available and receipt of prior grant approval does not guarantee subsequent grant approval.
HealthWell’s income limit is based on the patient’s adjusted gross income for the household. To calculate your patient’s household income for the purpose of applying to HealthWell, please consider the following sources of income:
- Employment (patient and spouse/partner, if any)
- Pension (patient and spouse/partner, if any)
- Supplemental Security Income (SSI-Social Security non-disability)
- Social Security Disability Income (SSDI)
- Unemployment Benefits
- Workers Compensation Benefits
- Aid from the Department of Public Welfare
- Alimony (does not apply if applicant is a child)
- Child Support (only applies if applicant is a child)
- Dividends, interest, or investment accounts
- Other (family, friends, other charities)
Once calculated, the income must range between 400 and 500 percent of the Federal Poverty Level, or somewhat more in cities where the cost of living is higher.
HealthWell randomly selects patients for income audits. If selected, your patient will receive a letter with instructions to complete the audit and if we have your fax number on file, you will receive a copy.
It is very important for patients to understand that if they receive a letter from HealthWell at any time requesting income documentation, they must reply right away. If they don’t, payments on their grant will stop or their HealthWell Pharmacy Card will be de-activated. In addition, the patient will have to submit income documentation to HealthWell for any and every new grant moving forward.
The terms and conditions are printed on the back of all approval letters and outline the parameters of the program related to the patient grant and receiving reimbursement.
For funds that do not provide a HealthWell Pharmacy Card, we encourage you to coordinate direct billing with us on behalf of your patient. Simply complete the Reimbursement Request Form and submit it to us with the needed documentation. We will mail the payment directly to you.
In order for patient grants to remain active, we must see payment activity on the grant. After 120 days of inactivity (i.e., no payment activity), the grant will close. If the grant closes, you may still submit eligible payment requests, however, we cannot guarantee funding will be available and payment made.
The Pharmacy Card is similar to an insurance card and the patient’s pharmacist should be able to use it to cover the patient’s copayment. The Pharmacy Card can also be used by specialty pharmacies and for mail order benefits. If the pharmacist has questions about how to use the Pharmacy Card, please ask him or her to call the pharmacist telephone number on the card.
If the patient received a Pharmacy Card but will receive treatment in the doctor’s office, clinic, outpatient setting, etc., we encourage you to coordinate direct billing with us on behalf of your patient. Simply complete the Reimbursement Request Form and submit it to us with the needed documentation. We will mail the payment directly to the provider.
- Can my patients use the HealthWell Pharmacy card for their specialty pharmacy or mail order prescription copayment?
Yes, if the insurer or prescription plan offers a specialty pharmacy or mail order benefit, the patient can use the Pharmacy Card for the copayment by providing the information included on the Pharmacy Card.
When a patient applies for a grant and is approved, the grant start date can be up to 30 days prior to the application date.
For example: If a new patient applies on July 1, 2015 and is approved, their grant start date will be June 1, 2015. Dates of service beginning on June 1, 2015 and after are eligible for reimbursement upon receipt of all required documentation.
Yes. All active grant recipients are welcome to re-enroll at the end of their grant cycle (one year) as long as assistance is still required and the individual still meets the program criteria and funding is available.