NeedyMeds

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1 NeedyMeds Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. REMEMBER - Send your completed application to address on the form, NOT to NeedyMeds. Did you know that NeedyMeds has thousands of other free resources? Here s a look at more ways we can help you save money on medicine and healthcare costs. Each one can be found under the Patient Savings tab on our website: Diagnosis-Based Assistance NeedyMeds lists thousands of assistance programs for almost any health condition. If you are going through chemo treatment for cancer, there are programs that can help with wig costs and scalp-cooling products. We also list resources for free diabetes testing supplies, caregiver lodging support, and much more. Free, Low Cost, and Sliding Scale Clinics This popular collection contains information on 16,000+ free, low cost, and sliding scale medical and dental clinics across the U.S. It s a great resource if you need affordable medical treatment and don t know where to go. Coupons, Rebates & More You can use the NeedyMeds website to find nearly 2,000 cost-saving opportunities for both prescription and over-the-counter drugs and medical supplies. Medical Transportation Need help getting to the doctor s office or medical facility? You may be eligible for financial assistance if you meet certain requirements. Finally, I want to tell you about the NeedyMeds Drug Discount Card. Thousands of people use this free, anonymous, and easy-to-use tool to get the best price on their medications. To date, our drug discount card has saved patients over $244,000,000. Check out the next page to learn more. Feel free to call our toll-free helpline if you have any questions. You can reach us at Monday-Friday, 9am-5pm Eastern Time. Thanks for using NeedyMeds! Please let us know if we can do anything else to help you afford the costs of your healthcare. Rich Sagall, MD Richard J. Sagall, MD President, NeedyMeds NeedyMeds.org P.O. Box 219 Gloucester, MA Phone: info@needymeds.org

2 Clip the card and save NeedyMeds NeedyMeds.org DRUG DISCOUNT CARD BIN: RX PCN: NMEDS RX GRP: PDFPDF ID: NMNA This is a drug discount program, not an insurance plan. NeedyMeds Drug Discount Card Patient: Simply present this card to a participating pharmacy to receive a discount on your prescription. Patients who have Medicare, including Part D, Medicaid or any state or federal prescription insurance can only use this card if they choose not to use their government-sponsored drug plan for their purchase. The card is not valid in combination with those programs. For questions concerning the card, call or visit Pharmacist: Card must be presented to receive program benefits. Clear system of prior cardholder information associated with this universal cardholder ID. For processing questions, call Argus Health Systems at Save up to 80% Use at over 65,000 pharmacies nationwide including all major chains Share the card with friends and family Use the card as often as needed Free, no fees or registration Never expires What if I have insurance? Anyone can use the card, but it can t be combined with insurance. You can use the card instead of insurance if: A drug isn t covered by your insurance Your insurance has no drug coverage You have a high drug deductible You have met a low medicine cap The card offers a better price than your copay You are in the Medicare Part D donut hole What drugs are covered? The card is good for prescription drugs, over-the-counter medicines and medical supplies if written on a prescription blank, and pet prescription medicines purchased at a pharmacy. You ll save on most, but not all, prescriptions. To obtain a plastic drug discount card, send a self-addressed stamped envelope to: NeedyMeds-PAP PO Box 219 Gloucester, MA The card is not valid in combination with other insurance plans, including Medicare, Medicaid or any state or federal prescription insurance. The card can be used only if you decide not to use your government-sponsored drug plan for your purchases.

3 PRESCRIPTION FINANCIAL ASSISTANCE PROGRAM AND OTHER FOUNDATION RESOURCES Background: The following information has been aggregated as a reference document for patients and stakeholders contacting UCBCares and/or partners requesting additional prescription financial aid with a scope extending beyond what is available from UCB. General Disclaimer: The information below is provided as a courtesy; however, please remember to visit the organization s specific website for terms, conditions and criteria for qualification, as these are subject to change. UCB does not endorse the following third parties and cannot guarantee any assistance. This is not an exhaustive list of financial assistance resources; however, it represents publicly available sources as well as those organizations where there is no conflict of interest for UCB (eg. UCB vendor). GENERAL PROGRAMS Partnership for Prescription Assistance (PPA) Background: PPA offers a single point of access to more than 475 public and private patient assistance programs, including more than 150 programs offered by pharmaceutical companies (includes assistance for the uninsured) Partnership for Prescription Assistance. Families USA 1201 New York Avenue NW, Suite 1100 Washington, DC Background: Families USA is a national nonprofit, non-partisan organization dedicated to the achievement of high-quality, affordable healthcare for all Americans. They have navigators to help patients choose the right plan for them. They do not offer any financial assistance Families USA. All Rights Reserved. Phone: CARE (2273) UCBCares@ucb.com

4 Modest Needs Foundation 115 E 30th St, FL 1 New York, NY Background: Modest Needs is an award-winning public charity with a simple but critical mission: they work to stop the cycle of poverty BEFORE it starts for the low-income workers whom conventional philanthropy has forgotten. Patients can apply for a short-term emergency grant Modest Needs Foundation. All Rights Reserved. Modest Needs is a 501(c)(3) not-for-profit corporation. Needy Meds P.O. Box 219 Gloucester, MA Background: Needy Meds is a non-profit with the mission of helping people who cannot afford medicine or healthcare costs. The information at Needy Meds is available anonymously and free of charge by NeedyMeds, Inc. Healthwell Foundation P.O. Box 4133 Gaithersburg, MD Background: The fund addresses the needs of individuals who cannot afford their insurance copayments, premiums, coinsurance or other out-of-pocket health care costs. This program is disease focused, and it also offers pediatric assistance funds designed to assist with copays for children with chronic disease HealthWell Foundation. GoodRx 233 Wilshire Blvd Suite 990 Santa Monica, CA Background: GoodRx features a drug price comparison tool. They do not sell the medications; however, GoodRx will show prices, coupons, discounts and savings tips for prescriptions at pharmacies near you GoodRx, Inc. Benefits Checkup-National Council on Aging th Street South, Ste 500 Arlington, VA Background: This website is a resource for Medicare Part D beneficiaries to determine if they can qualify for the low income subsidy. BenefitsCheckUp is a registered trademark of the National Council on Aging (NCOA), a nonprofit service and advocacy organization in Washington, DC.

5 SPECIFIC DISEASE/THERAPY AREA GROUPS EPILEPSY Epilepsy Foundation 8301 Professional Place East, Ste 200 Landover, MD Background: The Epilepsy Foundation, a national non-profit with nearly 50 local organizations throughout the United States, has led the fight against seizures since The Foundation is an unwavering ally for individuals and families impacted by epilepsy and seizures. The Foundation works to prevent, control, and cure epilepsy through community services; public education; federal and local advocacy; and supporting research into new treatments and therapies. The Foundation works to ensure that people with seizures have the opportunity to live their lives to their fullest potential. The website can direct patients to their local epilepsy affiliate that may provide an emergency medication fund Epilepsy Foundation of America, Inc. Landover, MD. All Rights Reserved. Caring Voice Coalition *Complex partial onset seizures or Lennox-Gastaut Syndrome indications only 8249 Meadowbridge Road Mechanicsville, VA Background: Provides comprehensive outreach programs to services aimed at financial, emotional and educational support for patients as well as friends, family and those who care for them. In addition, for financial assistance, they provide insurance education and counseling, and patient support programs for insured or underinsured patients. Please note: Complex partial onset seizures (POS) or Lennox-Gastaut Syndrome are covered; however, the medication covered with this service must be FDA approved for the indication. The patient must be insured but cannot afford copay, and meet income guidelines , All Rights Reserved. ARTHRITIS, CROHN S DISEASE, AND PARKINSON S DISEASE Arthritis Foundation 1355 Peachtree St NE, 6th floor Atlanta, GA Background: What They Do: Conquer Arthritis Leading the fight for the arthritis community, the Arthritis Foundation helps conquer everyday battles through life-changing information and resources, access to optimal care, advancements in science and community connections. Their goal is to chart a winning course, guiding families in developing personalized plans for living a full life and making each day another stride towards a cure. They also publish Arthritis Today, the award-winning magazine that reaches 4.2 million readers. 2016, All Rights Reserved. Crohn s & Colitis Foundation of America 733 Third Ave, Suite 510 New York, NY Background: Their mission is curing Crohn s disease and ulcerative colitis, and to improve the quality of life of children and adults affected by these diseases. They serve more than 300,000 patients annually through their 40 chapters as well as national education and support programs Crohn s & Colitis Foundation of America.

6 Parkinson s Disease Foundation 1359 Broadway, Suite 1509 New York, NY Background: Website directs patients or caregivers to resources that can help address matters such as employment, insurance issues, financial assistance and more Parkinson s Disease Foundation, Inc. Davis Phinney Foundation for Parkinson s 4730 Table Mesa Dr. Suite J-200 Boulder, CO Background: The Foundation provides essential information, practical tools and inspiration to people living with Parkinson s and funds research closely aligned with our mission improving the lives of people living with Parkinson s Davis Phinney Foundation. All Rights Reserved. Gooddays (formerly Chronic Disease Fund) 6900 Dallas Pkwy, Suite 200 Plano, TX Background: The fund provides financial support to patients who cannot afford their medication. Patients can often be approved in minutes. They also assist patients in finding the insurance coverage that best fits their needs. Patients who need to travel in order to receive treatment may also be eligible for travel assistance. The following is a list of the chronic diseases that Good Days is currently able to support: ankylosing spondylitis, rheumatoid arthritis, and Crohn s disease. Please note: Disease state funds may open and close throughout the year as funds are diminished or more funds become available. Contact Gooddays for more details Gooddays Gooddays is an independent 501(c)(3) non-profit organization. The Assistance Fund 4700 Millenia Blvd, Suite 310 Orlando, FL Background: The assistance fund offers financial assistance programs to children and adults diagnosed with critical or chronic illnesses. Copay Assistance Programs provide eligible underinsured individuals with financial assistance to cover all or part of the individuals out-of pocket cost for the supported medications. Financial Assistance Programs provide financial assistance for medication copays, health insurance premiums, and basic healthcare needs to children and adults. Health Insurance Premium Assistance Programs assist those who have health insurance but need help paying for their premiums. Notes: Primary insurance required, commercial or government sponsored. Patient must be diagnosed with a program-related illness, including: ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, Crohn s disease, or Parkinson s disease The Assistance Fund. Patient Access Network Foundation 1331 F Street NW, Suite 975 Washington, DC Background: Assists patients who cannot access the treatments they need due to out-of-pocket health care costs including deductibles, copayments and coinsurance. Patient must have health insurance and insurance must cover the qualifying medication for which patient seeks assistance. Patient must be diagnosed with a program-related illness, including: ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, Crohn s disease or Parkinson s disease. Each disease fund page includes the funding status, which is updated daily. Applicants should check website regularly as disease fund status can change Patient Access Network Foundation. All Rights Reserved.

7 CONNECT WITH UCBCares Phone: CARE (2273) Fax: UCB, Inc Lake Park Drive Smyrna, GA For additional information or to submit an online question, please visit our website. UCBCares is a registered trademark of the UCB Group of Companies UCB, Inc., Smyrna, GA All rights reserved. USP-MP