Eligibility
Most people who qualify don't know it yet.
Manufacturer prescription assistance programs have broader eligibility criteria than most people expect. Thresholds are designed to reach working-class and middle-income patients, not just those at the poverty line.
The only reliable way to determine your eligibility for a specific medication's program is to apply. We assess your situation as part of the process and give you a clear picture before we submit anything.
Who We Help
Common patient profiles that qualify.
While eligibility is always medication-specific, these are the profiles most frequently served by manufacturer assistance programs.
Qualifying Criteria
Six factors manufacturers typically consider.
Manufacturer programs set their own eligibility rules. These are the six criteria that appear most commonly across programs in our database.
Important: Income thresholds are not fixed. A program for one medication may accept patients up to $60,000/year while another may accept patients up to $120,000/year. The only reliable way to know is to apply.
Valid active prescription
A current prescription from a licensed US prescriber is required. The medication must be FDA-approved and the prescription must be active.
US citizenship or legal residency
Most programs require US citizenship or permanent legal residency. Some programs have broader requirements — we verify this for each medication.
Income within program thresholds
Most programs cover patients at 200–400% of Federal Poverty Level — higher than most people expect. Thresholds vary significantly by medication.
Appropriate insurance status
Programs typically serve uninsured, underinsured, or patients with high out-of-pocket costs. Some programs accept certain insured patients.
Medication on a supported program
The specific medication must have an active manufacturer assistance program. Our database covers 500+ medications with active programs.
Confirmed diagnosis
Most programs require physician confirmation of the medical indication — provided by your prescribing physician as part of the authorization.
- Uninsured patients with a valid prescription
- Patients on high-deductible plans with high specialty cost-sharing
- Medicare Part D enrollees with high out-of-pocket costs
- Patients with household income under 400% FPL
- Patients taking specialty or biologic medications
- Patients recently losing employer-sponsored coverage
- Part-time workers without employer benefits
- Patients with comprehensive employer insurance and low cost-sharing
- Patients above the program's specific income threshold
- Non-US residents
- Patients seeking generic medications (most generics have no PAP)
- Patients on active Medicaid in most states
These are generalizations. Specific program rules vary significantly. The only way to know for certain is to apply.
Transparency
When we can't help
We believe in being upfront about our limitations. These are situations where ProvisionRX is unlikely to be the right fit.
Emergency medication access
Manufacturer assistance programs take 4–10 weeks from application to approval. We cannot provide same-day or urgent medication access.
Generic medications
Most generic medications have no manufacturer assistance program. Generics are already low-cost — our service is designed for high-cost brand and specialty medications.
Active Medicaid coverage
In most states, Medicaid coverage disqualifies patients from manufacturer PAPs. Medicaid patients are generally not candidates for these programs.
Medications without active programs
Not every brand medication has a manufacturer assistance program. If your medication has no active program, we will tell you directly rather than take your enrollment fee.
Income significantly over thresholds
Programs have income ceilings. If your household income is well above the program's threshold, enrollment is unlikely to succeed and we will advise you accordingly.
Still not sure if we can help?
We review every application before we charge anything. If your situation doesn't fit our service, we will tell you — and suggest alternatives where we can.
We are not a discount card service. ProvisionRX is a managed advocacy service — we handle the full enrollment process from application through ongoing refills. Discount cards are a different (and much simpler) product.
Program availability varies. Manufacturer programs change their eligibility rules, income thresholds, and availability. We verify current program status as part of every enrollment.
Eligibility Questions
Eligibility FAQ
Program eligibility is complex and medication-specific. These are the most common questions we receive.
Ask us directly →The only way to know for certain is to apply.
It takes about 15 minutes. We assess eligibility as part of the process — no commitment required to start.