Safety note: Program rules, covered medicines, income limits, and insurance restrictions can change without notice. Do not deny, delay, or discourage a patient based only on this guide. Use it to route the case, then verify directly with the manufacturer or current application. A linked page or PDF is the official route located and reviewed; it is not proof that no newer document exists or that a patient will qualify.
Form-date warning: A PDF can carry a 2024 or 2025 edition date and still be the application currently posted on a manufacturer's live website. “Official form/application route reviewed” means the link was publicly posted on the manufacturer site on the review date; it does not mean a newer annual edition exists. Check the form itself and call the program when the date could affect a patient's case.
Application-audit key: A confirmed card does not mean its PDF has a 2026 edition date or that every product uses the same form. It means the official route was live and the listed core rule was supported by public materials. A verify card means a full current application was unavailable, a dated/general form did not clearly cover the current medicine list, or a rule is product-specific. Use the official route and contact the manufacturer when the card says Verify.
October 2, 2026 update: All 44 entries were rechecked against official manufacturer or program sources. This pass adds a manufacturer-by-manufacturer summary of published citizenship/residency wording, distinguishes explicit rules from silence, updates application routes and dated forms where confirmed, and refreshes the OOP comparison. It corrects the earlier Bausch + Lomb classification, restores the active Sumitomo Pharma America PAP, adds Supernus MYOBLOC, and clarifies current AbbVie, AZ&Me, and NovoCare routes. The companion link-audit JSON covers the original 146 unique URLs/241 listed link instances; newly added official source links were checked individually during this pass. Form dates are stated only when directly confirmed. A live route is not proof that a linked PDF is the newest edition.
Immigration / citizenship caution: “Citizenship not required” or no citizenship question does not guarantee eligibility. A rule that says only “U.S. resident” does not answer whether an undocumented applicant qualifies. Apply only the exact wording shown for that manufacturer and product; where the public source is silent, call the program before telling a patient yes or no. This is a summary of program documents, not legal advice.
Link audit: The companion JSON records the October 2 automated check of 146 unique URLs across 241 link instances: 140 returned HTTP 200 (including three redirects), none returned 404, and six returned HTTP 403 (four AbbVie URLs and two Lilly URLs). Lilly pages rendered in the in-app browser; AbbVie URLs resolved to official page titles but displayed no page content there, so access to those specific routes was not independently confirmed in that browser. This pass checked 30 additional distinct official-source URLs not covered by that report; 29 opened during source review. One Amgen editable application could not be retrieved by the browser tool and is dated April 2022 in search indexing; it has been removed as a current source. The linked Repatha form is product-specific, dated April 2025, and was included in the earlier automated check. The old BMSPAF August 2024 PDF URL redirected to the homepage and was replaced with the current medicine-specific selector.
Income-document audit | October 6, 2026: Every card now separates the program's income-verification method and any named proof documents from the separate no-income-letter answers. “Not stated” means no explicit rule was found in the current public source reviewed; it does not mean the document is rejected. A current form can be product-specific, request documents only after screening, or require a direct call for a case-specific answer. No reviewed current source clearly confirms that one program accepts both a patient-signed and an HCP-signed separate $0-income letter. Explicit patient-side instructions were found for AbbVie (letter; signer format not stated), GSK's vaccine form (patient checkbox only), and UCB (patient or personal representative letter). Explicit clinician-side instructions were found for Bausch Health, Bausch + Lomb, and Otsuka. Bayer lists provider or patient attestation among possible requested financial documents, but does not specifically identify that as a $0-income letter; it remains unconfirmed for that use. Some official pages, portals, and PDFs block automated retrieval or require interactive access. Where a current public document could not be read, the card says so or leaves the rule unstated; a blocked link is not treated as evidence that a document is rejected.
Review scope, form dates, and audit notes
Open out-of-pocket spending comparison
Out-of-pocket spending rules
A percentage-of-household-income threshold is not the same as a fixed dollar requirement or a plan's annual out-of-pocket maximum. Rules below apply only to the named applicant type and medicines. “Not found” means no universal minimum appeared in the reviewed public source; it is not proof that every product or case has no additional requirement. Confirm directly before advising or submitting.
| Program / scope | Verified OOP requirement | Limits and cautions |
|---|---|---|
| BMS Patient Assistance Foundation (Medicare applicants) | Current instructions require Medicare applicants to document out-of-pocket prescription expenses of at least 3% of annual household income during the same calendar year. | Household income is the denominator, but the public wording does not clearly establish whether a spouse's separate prescription spending counts. Do not assume pooling; confirm with BMSPAF. The live form selector generates a medicine-specific application; the old August 2024 PDF URL redirects to the homepage. |
| Amneal PAP (RYTARY, EMVERM, LIORESAL intrathecal, LYVISPAH; Medicare Part D) | At least 3% of annual household income spent out-of-pocket on prescription medicines. Instructions request proof of what the household spent this year. | The forms explicitly request proof of what the household spent, but do not spell out whether a spouse's separate prescription costs qualify; ask Amneal before pooling them. This differs from GSK, whose form expressly excludes family members' expenses. Amneal's live page still links older product forms; EMVERM is dated December 2021. Call to confirm the form version before filing. Do not apply this rule to CREXONT, Brekiya, or other Amneal support routes without product-specific instructions. |
| Daiichi Sankyo (TURALIO and VANFLYTA only; Medicare beneficiaries) | At least 3% of annual household income spent on prescription medicines in the current year; the patient must also not be eligible for or enrolled in Medicare Part D LIS/Extra Help. | This is verified for TURALIO and VANFLYTA, not established as a universal Daiichi rule. Public wording does not specify whose prescription costs are aggregated; confirm spouse/household pooling with AccessCentral4U. |
| GSK PAP (Medicare Part D applicants) | $600 in eligible prescription expenses paid by the individual applicant in the current calendar year. | Do not include monthly premiums or expenses of family members. Spouses cannot pool spending; each applying spouse must independently meet the requirement. Household income is assessed separately. |
| Pfizer PAP (applicable Medicare Part D / Medicare Advantage cases) | No fixed minimum dollar or percentage spend found. For a covered product, patients must enroll in MPPP, provide proof, attest they cannot afford the copay and have not reached the annual OOP maximum, and apply to relevant available alternate funding resources. | The $2,100 amount Pfizer cites for most patients is the 2026 Part D annual maximum, not a PAP minimum-spend requirement. Product and case rules apply. |
| Amgen Safety Net Foundation (certain covered Medicare Part D products) | The patient must demonstrate inability to afford the out-of-pocket cost; no general minimum dollar or percentage threshold was found in the current public materials reviewed. | Applies only to certain Medicare/product circumstances. The brochure also lists other conditions, including LIS/Medicaid and other-support restrictions; check the current product route. |
| Bausch Health PAP | The application requires a pharmacy statement showing the patient's total out-of-pocket responsibility for the prescription. No minimum dollar or percentage floor is stated in the public application/terms reviewed. | Cost documentation is not the same as a minimum-spend threshold. Commercial, Medicare, and Medicaid product coverage rules are case-specific. |
| Bausch + Lomb PAP (select products) | The current eligibility tool asks for monthly medication OOP and a pharmacy/insurer cost statement. No universal minimum dollar or percentage threshold is published in the reviewed public rules. | This is a separate PAP from Bausch Health. Use the product list and current eligibility tool; do not infer that cost documentation alone establishes eligibility. |
| Novartis NPAF (historical rule not confirmed current) | The current 2026 portal does not publish a universal OOP spend threshold. A search-indexed 2024 product grid reported an 8% medication-OOP rule for select commercially insured cases, but the official PDF endpoint returned 404 in this review. | Treat the 8% figure as historical/unverified, not a current eligibility rule. Confirm the exact product's current criteria with NPAF. |
Filter entries
Status key
Yes
No
Conditional
Verify / not stated
N/A
Definitions: "Credit / income screen" separates a form that expressly says its inquiry will not affect a credit score from a form that only authorizes a credit profile or consumer report to estimate income. "Yes" means the current public source expressly says the inquiry will not affect the score. "Conditional" means a credit/consumer-report income screen is described but score impact is not stated. "MDL" means Medicaid denial letter or equivalent Medicaid denial documentation. "Private/commercial" means the PAP or related manufacturer access path may accept commercially insured patients in at least some circumstances; it does not mean copay cards can be used with government insurance. "No-income letters" are shown separately for the patient and prescriber/HCP. "Yes" means the reviewed current FAQ/form expressly describes that source; "No" means the reviewed instructions identify another signer or exclude that source; "Not stated / verify" means the reviewed public materials did not answer this exact question and is not a denial.