What about people who are completely uninsured? I'm 34, self-employed, couldn't afford ACA marketplace plans this year (cheapest in my county was $480/month with a $9,000 deductible).
I make about $44,000/year. BMI is 35. My PCP wants me on a GLP-1 but at $1,349/month for Wegovy, that's obviously impossible without insurance.
Do these PAPs cover uninsured patients? Or only Medicare?
Yes, both Novo Nordisk and Lilly PAPs cover uninsured patients who meet the income requirements. At $44K/year, you'd be under the 400% FPL threshold.
However, for uninsured patients, they may ask you to first apply for insurance coverage (including Marketplace plans). If you can document that available plans are unaffordable or don't cover the medication, they'll generally accept that.
Another option for uninsured patients: NeedyMeds.org maintains a comprehensive database of all patient assistance programs, including some smaller programs and charitable organizations that provide financial assistance for medications. It's free to search.
Also look into Rx Outreach — they're a nonprofit pharmacy that provides medications at reduced costs for low-income patients. They don't carry GLP-1s currently but they carry many common medications, which could free up budget for GLP-1 costs.
Important heads up for anyone on a PAP: these programs require annual renewal. I've been on the Lilly Cares program for Mounjaro for 18 months now. The renewal process requires updated income verification and a new provider attestation.
I almost had a gap in coverage because I didn't realize the renewal was due and missed the deadline by a week. It took 3 weeks to process the renewal, and I had to go without medication for 2 weeks.
Set a calendar reminder for 60 days before your PAP annual renewal date. Start the paperwork early. Don't be like me.
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Browse GL BiochemUpdate: I submitted my Novo PAP application yesterday. My doctor's office was very familiar with the process — they said they do about 10 of these per month. They completed their section same day.
I also asked about the Extra Help / Low-Income Subsidy program that someone mentioned in another thread. I apparently qualify for partial Extra Help based on my income and assets, which will help with my other Part D medications too.
Between the PAP for Ozempic and Extra Help for my other drugs, my monthly medication costs could drop from $412 to under $30. I'm honestly emotional about this. No one should have to choose between medication and food, but that's the reality for too many of us on fixed incomes.
Thank you all for the guidance. I'll update when I hear back from Novo.