Recommended Resources

Written By Halley Ray

Tools, Advocacy Platforms, and Additional Reading

DISCLAIMER: This isn’t intended to be a comprehensive list, but rather a curated set of standout resources tied directly to the themes we covered in the webinar.

We curated a shortlist of standout resources tied to the topics covered in the webinar—from practical tools and advocacy platforms to explainers and educational series.

Enrollment & Policy Information

Patient/Consumer Guides

Alternative Funding Programs

Disclaimer: Last updated January 2026. Program availability, eligibility criteria, and funding levels change frequently — please read the fine print before applying.

→ National, Multi‑disease Medication Assistance Foundations

→ Disease‑Specific and Category Programs

→  Manufacturer Patient Assistance Portals (Drug Specific)

Not sure who makes your drug? Visit No Patient Left Behind’s “Call the Inventors” tool to look up the inventor behind your medicine. Many companies offer Patient Assistance Programs that can help with coverage, affordability, or overcoming insurance barriers. Enter your drug name in the lookup chatbot to find the inventor, then check their site for Patient Support or Assistance Program links.

→ 340B Program Assistance at Nonprofit Hospitals

Nonprofit hospitals and community health centers participating in the 340B Drug Pricing Program can purchase outpatient medications at discounted rates. Patients may benefit through hospital‑run medication assistance programs, which pass on savings in the form of reduced copays or free medications.Eligibility varies by hospital; typically income‑based or tied to charity care policies.

You can look up which hospitals and clinics participate in the 340B Drug Pricing Program using the official HRSA database.

Crucial Step: Ask the hospital’s financial assistance office or pharmacy department about 340B‑linked programs when seeking help with medication costs.

Patients can access the 340B Program by directly inquiring at their hospital or community health center. Because many people don’t realize the program exists, it’s important to ask whether discounted or free medications are available. The financial assistance office or pharmacy staff can explain if 340B savings are passed on to patients and what documentation is required.

You can also look up which hospitals and clinics participate in the 340B Drug Pricing Program using the official HRSA database.

Checklist for Reviewing Health Plans

Ask yourself: will this plan meet my needs for routine care and also protect me if new medical needs arise? Not just in theory, but when I’m actually relying on it. Keep that perspective in mind as you walk through the checklist:

How to Review Plans:

  • Check your provider network: Are your doctors and specialists covered?

  • Review prescription coverage: Are your medications included, and in what tier?

  • Estimate total yearly costs: Look beyond premiums — add up deductibles, copays, coinsurance, and the out‑of‑pocket maximum.

  • Consider your health needs: Chronic conditions or frequent care may justify higher‑tier plans.

What’s Changed in Your Plan:

  • Premiums: Has the monthly cost gone up or down?

  • Deductibles: Has it increased?

  • Copays & coinsurance: Are your costs for office visits or prescriptions changing?

  • Network: Are your doctors, hospitals, or specialists still covered?

Formulary: Are your medications still covered, and in what tier?

How to Identify Co-Pay Accumulators

Check your Explanation of Benefits (EOB): If you used a copay card and the amount paid doesn’t show up as progress toward your deductible or out-of-pocket max, that’s a red flag.

  • Review your Summary of Benefits and Coverage (SBC): Look for language like:

    • “Third-party payments do not count toward deductible or out-of-pocket maximum.”

    • “Copay assistance will not be applied to member cost-sharing limits.”

  • Ask your HR department or benefits manager directly: Employers often choose whether to allow accumulator programs. Ask:

    • “Does our plan use a copay accumulator or copay maximizer?”

    • “Do manufacturer copay cards count toward my deductible?”

  • Call your insurer and ask specific questions: Don’t just ask if copay cards are accepted — ask:

    • “Will the amount paid by a manufacturer copay card count toward my deductible or out-of-pocket maximum?”

Common Warning Signs

  • Your copay card works, but your deductible doesn’t budge. You’re still far from meeting your deductible even after months of using assistance.

  • Sudden spike in costs mid-year. When the copay card maxes out, you’re hit with the full cost of the drug — often thousands of dollars.

  • Confusing or vague plan language. If your plan uses terms like “copay adjustment program,” “copay maximizer,” or “alternative funding,” dig deeper — these often signal accumulator-like behavior

What to Look For: Reading a Formulary List

Most families don’t realize their drug coverage can change quietly — until they’re hit with surprise costs. That’s why our resource hub includes step-by-step guidance on how to read a formulary.

Here’s what to scan for:

  • Drug Name Formatting Italics = generic (usually lower cost) CAPITALS = brand-name (often higher cost)

  • Tier Level Lower tiers = lower copays. Specialty tiers = 40%+ coinsurance — often for life-saving drugs that may also need to be filled through a specialty pharmacy.

  • Requirements & Limits Look for abbreviations like:

    • MO = mail order only

    • QL = quantity limits

    • ST = step therapy

    • ED = excluded drugs 

These flags can mean delays, denials, or extra hoops to jump through.

Coverage Gaps Some drugs are not covered during the Medicare “donut hole” — look for LGA (not in gap) or B/D (covered under Part B or D).

Halley Ray
Next

Terms & Definitions