Patients & FamilyYou take care of yourself. We’ll take care of the financial strain.

At Patient Advocate Foundation Co-Pay Relief Program, we put patient and family peace of mind above all else. We provide direct payment for co-pays, co-insurance, and deductibles for patients who need financial assistance.

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Quick Search

Our tool allows you to quickly search for certain account information without having to log into your portal account or calling into the program.

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What can we help with?

PAF’s Co-Pay Relief (CPR) program provides direct financial assistance to qualified patients with co-payments, co- insurance or cost-sharing associated with prescription drugs through funds dedicated to specific disease states. In some instances, assistance with insurance premiums and/or ancillary services associated with the disease also may be available.

Required Information to Complete an Application for Assistance:

Patient Demographic Information

First & Last Name
Address & Phone Number
Gender, Ethnicity & Marital Status
Veteran Status, Employment Status, Date of Birth
Social Security Number or Alien Number
Financial Information
Number in Household

Annual Household Income

Do you file a Tax Return for the most current year?
Has your Annual Income changed significantly from last year?

Authorized Person

Is anyone else authorized to speak with CPR on the Patient’s behalf?
If yes, the following fields are required: First Name, Last Name, Relationship, Special Authorization, Phone
Number

Insurance Information

Primary Insurance Carrier Insurance & Plan Type Policy ID & Group Number Telephone Number
Subscriber’s Name and Date of Birth
Co-Pay or Coinsurance for medical services
Co-Pay or Coinsurance for pharmacy benefits
Do you have Medicare Part D?
Does the patient have a Medicare Supplement? Do you have Secondary Insurance?
Is Insurance coverage continuation under COBRA in effect?
Does this plan cover prescription drugs at the pharmacy and provider office?

Treating Physician Information

Physician Name Facility Name Physical Address
Phone and Fax Number
Office Contact Name and Email Address, if known

Medical Diagnosis

Primary Diagnosis
Date of Diagnosis

Treatment Plan

Confirmation you have a treatment plan and are currently in treatment, have been in treatment in the last 6 months or will begin treatment in the next 60 days.

Submitting Documents: What are the options?

CPR accepts documents via Virtual Pharmacy Card, electronic upload, fax or by mail

For applications submitted through our website, supporting documents may be uploaded electronically

Please allow 24 to 48 hours for uploaded documents to reflect on the online portal.

Applications and supporting documents may be faxed

Please use the unique bar-coded fax coversheet when faxing information to CPR.
Please note that each application submission has a unique bar code and the applications are not interchangeable.

Mail application and supporting documents

Program Contact Information:
Web Portals: www.copays.org
Phone Number 866-512-3861 Fax Number: 757-952-0119
Address: Patient Advocate Foundation Co-Pay Relief Program; 421 Butler Farm Road, Hampton, VA 23666

I’m Approved, What Now?

Patients approved for assistance are required to have their verified diagnosis and treatment plan along with supporting documentation completed and returned within 30 days of approval to ensure continuation of the award.
Your treating physician can upload the diagnosis and treatment plan document(s) to the online portal or fax to us using the unique bar-coded fax cover sheet.
Approved patients who do not submit a completed physician form verifying the reported diagnosis within 30 days from approval will forfeit their award and will not be eligible to reapply to the program until 12 months from the original date of approval.
If you are requested to provide documentation of your reported income, please submit your documentation to the program within 30 days of approval to ensure continuation of the award.
If the requested income documents are not received within 30 days from the date the application was initiated, the award will be forfeited, and you will not be eligible to reapply to the program until 12 months from the original date of the application.
Income documents can be uploaded to the online portal or faxed to us using the unique bar-coded fax cover sheet.
Once approved, begin using your award immediately! Please submit your claims via Virtual Pharmacy Card, uploading them to the online portal or faxed to us using the unique bar-coded fax cover sheet.

Must be currently insured and have coverage for medication seeking financial assistance
Have a confirmed diagnosis and treatment plan
Must reside and receive treatment in the United States
Income must fall at or below 300% or 400% of the Federal Poverty Guideline (FPG) with consideration for the Cost of Living Index (COLI) and number in the household
Applications can also be completed by contacting us toll free at 866-512-3861, to be connected to a CPR Specialist

Welcome to the Co-Pay Relief program!

Patient Resource Center- National Financial Resource Directory

How do I apply for assistance?

Apply Online

Complete the application for assistance, entering all of the required information
Once you have fully completed the application you will be notified immediately if you are eligible for financial assistance
If you are eligible for assistance, the application will be instantly approved, and you will be enrolled into the program.
You will have immediate access to your award and pharmacy card

Call Us to Apply: 1-866-512-3861

Our Program Specialists are available to personally guide you through the application and enrollment process.
You will need to have the required information available when you call to apply
If you are eligible for assistance, the application will be instantly approved, and you will be enrolled into the program.
You will have immediate access to your award and pharmacy card

Apply

Patient & Family Resources

" With your help I am able to purchase the drugs that will help me finally beat this illness and be rid of it for good. Thank you so much. "

Stan | Hepatitis C

" The impact has been lifegiving. Without your financial assistance, I would not have had the resources to afford the treatments that I need. We have talked with a number of people on your staff, and everyone has been helpful and professional, and most importantly, has seemed genuinely interested in my well-being. I am grateful beyond words. "

Curtis | Myelodysplastic Syndrome

" …The application process was very straight forward and easy to fulfill… I always felt a feeling of caring and compassion to assist someone in need…I cannot thank you enough for your generous grant to help offset my financial obligation for payment towards my cancer [treatment]… "

Michael | Metastatic Prostate Cancer

" It is with enormous gratitude that I accept your most generous donation… this indeed helped offset some expenses, the cost of which seems to rise daily. I take great comfort in knowing that your group is out there to assist those of us who have had the misfortune to fall ill to the mysteries of cancer… God bless your wonderful organization for all that you do for so many people in need. "

Sylvia | Breast Cancer

" … a life saver for a person going through cancer….You have lifted a burden off my shoulders and I can concentrate on my treatment and recovery without worrying about the cost! I appreciate all the help your foundation does for those who need assistance. "

Samuel | Myelodysplastic Syndrome

" Without this assistance, I would have to choose what to go without to ensure that I had money for my treatment. Thank you! "

Roberto | Prostate Cancer