Eligibility Overview

Do I Qualify?

Eligibility for patient assistance programs varies by medication and manufacturer. The factors below cover the most common qualifying criteria — but the only way to know for certain is to apply. We check every program your medications may qualify for.

Important: RX Advantages does not determine your eligibility. That determination is made solely by the pharmaceutical manufacturer. We help you apply to every relevant program and present your information accurately.
Secure clipboard with eligibility checklist — income level, insurance status, valid prescription, and residency requirements for prescription assistance programs

Common Qualifying Factors

US Citizen or Legal Resident

Most programs require US citizenship or lawful permanent residency. Programs typically require a valid US address for delivery coordination.

Valid Prescription

You must have an active prescription from a US-licensed physician for the medication in question. Physician contact information is required as part of the application.

Income Within Program Thresholds

Most programs target patients below 200–400% of the Federal Poverty Level. Exact thresholds vary significantly by manufacturer and medication. Higher incomes may still qualify for some specialty programs.

Insurance Status

Many programs are designed for patients without adequate prescription drug coverage. Some patients with insurance (or Medicare Part D) may still qualify for certain manufacturer programs — eligibility depends on the specific drug.

Medication-Specific Requirements

Each manufacturer sets its own eligibility rules for each drug. A medication you take may have different income thresholds, diagnosis requirements, or insurance exclusions than another medication from the same company.

Diagnosis Confirmation

Some programs — particularly for specialty medications — require documentation of a specific diagnosis from your physician. We help coordinate this requirement.

Patients Who Often Qualify

Uninsured patients with a valid prescription
Underinsured patients whose plan doesn't cover the specific medication
Patients whose medication was recently denied by insurance
Medicare beneficiaries without Part D, or those in the coverage gap
Patients who have recently lost employer-sponsored coverage
Low-to-moderate income patients on brand-name specialty medications
Patients who cannot afford their copay even with insurance

Patients Who Often Do Not Qualify

Full Medicaid recipients (most manufacturers exclude Medicaid patients)
Patients with comprehensive commercial drug coverage that covers the specific medication
Patients whose income significantly exceeds program thresholds
Non-US residents or those without a valid US prescription
Patients seeking medications that have no manufacturer PAP

Even if you're uncertain, it's worth applying. Program criteria change, exceptions exist, and we check every available option. We don't know until we look.

The Only Way to Know Is to Apply

Our team reviews every application individually and checks all programs your medications may qualify for — including some you might not find on your own.

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