TotalAssist Program Terms & Conditions

All applications for assistance submitted to Patient Advocate Foundation’s Co-Pay Relief will be accepted on a first-come, first-serve basis and receive an instant eligibility decision at the time of submission based on the information supplied and availability of funding. 

Eligibility decisions will be made using the patient’s reported income, diagnosis, and insurance coverage information.

To be eligible for support from CPR the patient must meet the following criteria:

• Have a confirmed diagnosis by the patient’s care team of a disease covered within our TotalAssist Program.
• Have a household income of 500% or less than the Federal Poverty Level (FPL) guidelines, adjusted by the Cost-of-Living Index (COLI) for where the patient lives. For specific income requirements regarding each individual disease fund, please visit our listing of disease funds. 
• Have active insurance coverage that includes coverage for pharmaceutical products.

Patients who are approved for assistance can begin submitting claims immediately via faxing, in their portal account, by TotalAssist Pharmacy Card (pharmacies only), and by mail. (link) 

Patient Advocate Foundation TotalAssist staff will contact all approved patients’ care team to verify patient diagnosis. (link) 

Patient Advocate Foundation will be confirming the patient’s reported income through a third-party income verification service to ensure that it is within the income eligibility guidelines for the program. If we are unable to verify that the patient’s reported income is in compliance with program guidelines, we will send a letter to him/her requesting they provide proof of income documentation along with documentation verifying the patient’s Social Security Number. The patient will have 30 days to respond to this request.

1.1. Applicants understand that all applications for assistance are processed on a first-come, first-serve basis as long as there is funding available.

1.2. Applicants agree that the information provided in the application for assistance is truthful and accurate.

1.3. Applicants will be notified of their eligibility for assistance immediately upon application to the program.

1.4. Applicants understand that to be eligible for support from TotalAssist they must meet the following criteria:

1.5. Have a qualifying diagnosis verified by a member of the patient’s care team.

1.6. Have a household income of 500% or less of the Federal Poverty Level (FPL) guidelines, adjusted by the Cost-of-Living Index (COLI) for where the patient lives. For specific income requirements regarding each individual disease fund, please visit our Disease Funds page.

1.7. Have active insurance coverage that includes coverage for pharmaceutical products.

1.8. Applicants agree to notify Patient Advocate Foundation (PAF) if the financial situation, insurance status, or medical conditions change from what has been documented in the application.

2.1. All patients approved for assistance are required to have their diagnosis and treatment verified by a member of the patient’s care team within 30 days of approval.

2.2. Approved patients authorize and understand that the TotalAssist staff will contact his/her treating physician/provider in order to verify his/her diagnosis and treatment status.

2.3. If the application is initiated by the patient, the TotalAssist staff will fax the required Physician Form to the treating physician on behalf of the patient.

2.4. Completed forms should be uploaded electronically, faxed, or mailed to the program.

2.5. Approved patients can submit claims for payment during this period.

2.6. Approved patients who do not have their reported diagnosis and treatment plan verified by their care team within 30 days from approval will forfeit their award.

2.7. If the patient is still in need of assistance and is able to comply with the program documentation requirements, they may contact a CPR Program Specialist at 866-512-3861. We will review additional documentation submitted by the patient on a first-come-first-serve basis, and if funding is available for his/her diagnosis, we will review and reinstate their award if all program eligibility requirements are met.

3.1. Applicants understand that we will be confirming your reported financial information to ensure that it is within the income eligibility guidelines for the program.

3.2. Patients who we are unable to verify the information provided on the application will undergo further review. Proof of income documentation along with documentation verifying the patient’s Social Security Number (SSN) must be submitted within 30 days in order to process the patient’s application. Claims will not be processed while the patient’s account is pending review.

3.3. Patients who have a household income in excess of program guidelines upon review of submitted income documentation will no longer qualify for support and forfeit their award.

3.4. If the patient is still in need of assistance and is able to comply with the program documentation requirements, they may contact a CPR Program Specialist on 866-512-3861. We will review additional documentation submitted by the patient on a first-come-first-serve basis, and if funding is available for his/her diagnosis, we will review and reinstate their award if all program eligibility requirements are met.

4.1. Applicants approved for assistance understand that PAF offers financial support to insured patients who financially and medically qualify.

4.2. The financial support provided by the program can be utilized to pay for co-payments, co-insurance, and deductibles required for medications prescribed for the treatment and management of the disease for which a patient is approved for assistance.

4.3. Approved patients will have 12 months from the date of approval to utilize the award.

4.4. Approved patients have a 6 month look back period from the date of approval. Eligible claims from this 6-month period can be submitted to CPR for payment.

4.5. Claims can be submitted to CPR for payment via Virtual Pharmacy Card, electronic upload into the portal, faxed using the unique bar-coded fax cover sheet or mailed.

4.6. Claims can be paid via Virtual Pharmacy Card, Electronic Funds Transfer (EFT) or check.

5.1. Patients approved for assistance are expected to utilize their award.

5.2. Approved patients who exceed 120 days with no processed claims at any time during their 12-month award period will forfeit their award.

5.3. If the patient is still in need of assistance and is able to comply with the program documentation requirements, they may contact a CPR Program Specialist at 866-512-3861. We will review additional documentation submitted by the patient on a first-come-first-serve basis, and if funding is available for his/her diagnosis, we will review and reinstate their award if all program eligibility requirements are met.

6.1. Applicants agree that PAF and its donors will not be liable for any damages of any kind, without limitation to the success or failure of medication(s), or for any harm that it may cause.

6.2. Applicants understand that PAF makes every effort to grant assistance when needed, however, the program is limited by available resources and may be discontinued or changed at any time.

6.3. Applicants understand they are financially responsible for any and all charges not covered by the CPR program.

6.4. While enrolled in the Co-Pay Relief program, approved applicants have complete freedom to choose and or change doctors, providers, suppliers, insurance companies and/or treatment related medications without affecting continued eligibility.