Frequently Asked Questions
HealthWell provides financial assistance to eligible individuals to cover coinsurance, copayments, health care premiums and deductibles for certain medications and therapies. If you’ve been prescribed a medication and your insurance company covers it, but you still cannot afford the coinsurance or copayment required, we may be able to assist you by paying for part of your costs associated with the medication. Also, if you are eligible for health insurance, but cannot afford the insurance premium, we may be able to assist with your insurance premium.
The terms and conditions are printed on the back of all approval letters and outline the parameters of the program related to your grant and receiving reimbursement.
At this time, the HealthWell Foundation is able to assist patients receiving treatments only for selected diagnoses. The HealthWell Foundation adds new funds throughout the year, so please visit this site regularly for the latest information.
To qualify for assistance, you must meet HealthWell’s insurance, income, and medical criteria. If you call us, we can screen you to see if you are likely to qualify. Or, answer a few short questions online and immediately learn whether you are eligible for assistance.
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 person is being treated for a specific disease for which funding is currently available; the person has insurance that covers the treatment for this disease; and the medication is dispensed in the United States.
HealthWell assists uninsured patients who need help paying for their insurance premiums. If you are eligible for an insurance plan that would pay for your treatments, but are 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 you to other resources that may be helpful, such as drug manufacturers’ patient assistance programs and state prescription assistance programs. See HealthWell’s 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.
- I am receiving assistance from the company that makes my medicine, can you help me with the balance?
HealthWell is a charitable cost-sharing program and we focus our assistance on patients with high out-of-pocket costs. In an effort to help as many patients as possible, we cannot help patients who have less than a $5.00 responsibility after the manufacturer assistance is applied. If your situation changes, you are welcome to contact us again.
HSAs and HRAs are not traditional insurances. If you have an HSA or HRA account, consideration will be 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 you meet all eligibility requirements, we do not require patients to exhaust his/her Flexible Spending Account (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.
The easiest and fastest way to apply is to complete your application online. Simply follow the prompts and answer all required fields to continue through the application until you are done.
If you do not have access to a computer, please call us at (800) 675-8416 and we will collect the required information over the phone. Or, you may have a friend or relative with a computer apply on your behalf as long as you give them permission.
Once you are approved, whether by phone or online, a letter with your grant information and next steps will be mailed to you.
HealthWell provides instant approval. You will know immediately when you speak with us, or apply online, whether or not the patient is approved based upon the answers you provide.
HealthWell may approve patients for assistance with insurance premiums from one fund and copayments from a second fund, but never both types of assistance under one fund.
Each fund has a set grant cap. You can view the fund profile, including the cap amount, on our Diseases and Medications page.
The HealthWell Foundation pays only copayments related to prescription or biologic treatments you are taking specifically for the medical condition listed in your application.
- What happens if my physician changes my prescription while I am enrolled in the program? Does the amount of my grant change?
You are free to change the therapy you are using at any time, as long as your physician has prescribed an eligible therapy for the disease area in which you are enrolled. You are free to switch your treatment, physician, or pharmacy at any time and it will not affect your eligibility for assistance or change the amount of your award.
After approval via phone or online, we will send you an approval letter with 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 others, the approval letter will include a Reimbursement Request Form depending on the type of assistance you requested. The Reimbursement Request Form includes full instructions on how to submit for reimbursement. In addition, we will fax a copy of the approval letter to the provider as long as their fax number was provided.
The HealthWell Foundation is only able to assist individuals who make less than a certain income, and we require proof of your family’s income to determine whether you are eligible for assistance. Specifically, your household’s (not just you) total income including non-taxable portions must range between 400 and 500 percent of the Federal Poverty Level, or somewhat more in cities where the cost of living is higher. For example, a family of 2 can earn a total household income of up to $58,280 (or slightly more in some high cost cities) and qualify for assistance.
To calculate your household income for the purpose of applying to HealthWell, please consider the following source of income:
- Employment (yourself and spouse/partner, if any)
- Pension (yourself 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
- Non-taxable or tax sheltered benefits or payments
- Capital or business income/losses (incurred in the year they were reported)
- Other (family, friends, other charities)
If you do not have access to a computer, please call us at (800) 675-8416 and one of our representatives will collect the required information for eligibility determination.
HealthWell operates on a rolling 12-month grant cycle; all grant enrollments cover a 12-month period. Re-enrollment can be completed through our online application or by calling us at (800) 675-8416 no more than 3-4 weeks in advance of the grant end date. 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.
In order for patient grants to remain active, we must receive the first complete reimbursement request within 120 days of the date on your approval letter and continue to receive a complete reimbursement request at least every 120 days. After 120 days of inactivity on your grant (i.e., no payment activity), the grant will close. If your grant closes, the patient, provider, or pharmacist may still submit eligible payment requests, however, we cannot guarantee funding will be available and payment made.
In an effort to be the best stewards of our donated dollars and to serve the most patients possible, we use in a multi-faceted fraud detection system and have numerous fraud auditing flags and procedures in place.
When you use your pharmacy card for the first time or submit any paperwork for reimbursement, you will have accepted and agreed to be bound by all terms and conditions outlined in your patient approval letter. Every patient is subject to a random fraud audit. Accounts will be heavily audited on a daily basis and at any time you could be asked to produce verification of any information you verbally provided to HealthWell in support of your grant application. This not only applies to individuals, but it applies to providers as well.
For funds that do not provide a HealthWell Pharmacy Card, your approval letter will include a Reimbursement Request Form based on the type of assistance you requested. In order to process a payment, we must receive the completed Reimbursement Request Form along with all required documents outlined on the form.
Many times we are able to coordinate billing with your pharmacy or physician. In these cases, we will send the payment directly to them after you have received your medication. They can simply complete the Reimbursement Request Form as appropriate, submit it to us with the needed documentation and we will mail the payment directly to your pharmacy, physician, or insurer.
If you have already paid the premium or copayment, you can complete the Reimbursement Request Form yourself, submit it to us with the needed documentation, and HealthWell will send the reimbursement check to you.
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 is approved on July 1, 2015, 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.
Simply take the letter with you to the pharmacy when you fill your prescription, or call your specialty or mail order pharmacy and provide the numbers on the card. The card is similar to an insurance card and your pharmacist should be able to use it to pay your copayment for your treatment. Make sure the pharmacist runs ALL OTHER INSURANCE and PRESCRIPTION cards FIRST before running your HealthWell Pharmacy Card. If your pharmacist has questions about how to use the HealthWell card, please ask him or her to call the pharmacist telephone number on the card.
If you received a HealthWell Pharmacy Card and cannot use it to pay for your treatment, please email us at firstname.lastname@example.org or call (800) 675-8416 for more information about your options.
- I get my prescriptions filled using my mail order pharmacy. Can I use my HealthWell Pharmacy card for my mail order prescription copayment?
Yes, if your insurer or prescription plan offers a mail order or specialty pharmacy benefit, you can use your HealthWell pharmacy card for the copayment. Simply call your mail order benefit and provide the HealthWell card number, BIN number . . . Be sure to explain to use this card AFTER using your primary, secondary insurers first.
- Do I have to go to the retail pharmacy? Copayments for my prescriptions in the pharmacy are so expensive. Are there any other options?
You should ask your insurer if you have a mail order or specialty pharmacy benefit with your prescription plan. Mail order may be cheaper because you receive a greater supply of medication with the same, or slightly higher copayment. For example, instead of a 30-day supply at the pharmacy, you can get up to a 90-day supply, with your doctor’s approval, using mail order. And depending on your plan, you may pay the same copayment, or a slightly higher copayment for that larger amount than for three smaller fills at a retail pharmacy.
Drug X (Name Brand) Drug X (Name Brand) 1st 30-day supply, copayment $250 90-day supply, copayment $500 Refill #1: 30-day supply, copayment $250 Refill #2: 30-day supply, copayment $250
TOTAL SPENT $750
TOTAL SPENT $500
You can check on your grant any time online through the Patient Portal.
The HealthWell Foundation customer service phone lines are open from 9:00 a.m. to 5:00 p.m. Eastern Time, Monday through Friday. We are closed on Federal holidays. The best time to call is before 10:00 a.m. You may also use our automated telephone system, send a fax, apply online, or visit our website any time day or night at your convenience.
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.