PHLP provides free legal services and advocacy to Pennsylvanians having trouble accessing publicly funded health care coverage or services. For assistance, call our helpline at 1-800-274-3258 or 1-866-236-6310 TTY or e-mail us at staff@phlp.org.

Problems with accessing prescription drugs may include not being able to pay for the drugs you are prescribed because you lack insurance coverage for prescription drug coverage or getting a denial from your insurance company saying they will not cover the drug that your doctor prescribes.

If you do not have prescription coverage…

There are several programs in Pennsylvania that might be able to assist you. Here are just a few ideas:

- Need help with prescription drug costs? Click here for a flyer explaining ways to help with your prescription drug costs through the Pennsylvania Patient Assistance Program. Or click here to find out if you may be eligible for assistance with your prescription drug costs through the MedCo settlement.

- Medical Assistance provides free prescription coverage for many consumers. To see if you might qualify, consult our quickscreen tool.

- If you are 65 years or older, you may qualify for PACE or PACENET, Pennsylvania's drug benefit for seniors. For more information, please see the PACE website. Click here for PHLP's Brochure on Understanding the PACE Program (in pdf August 2007)

- There are also programs for people with schizophrenia or HIV/AIDS whose income is too high for Medical Assistance. You can download an application for the Special Pharmaceutical Benefits Program for HIV/AIDS and the Special Pharmaceutical Benefits Program for Schizophrenia on our website.

- If you do not qualify for Medical Assistance or any of the other programs mentioned here, you may be able to get some of your prescription drugs for free from the drug companies. NeedyMeds and RxAssist are two websites that help you find out which drug companies have Patient Assistance Programs for particular drugs.

- If you have Medicare, you can enroll in a prescription drug plan and may be eligible for "extra help" paying for your medication. See our Medicare page for more information.

For more information on accessing prescription drugs, please see our brochure on How to Access Prescription Coverage. If you have any questions about any of these programs, please contact the Pennsylvania Health Law Project at 1-800-274-3258.

If you have trouble getting your insurance company to pay for your prescription drugs…

Many insurance companies use a formulary, where certain drugs are listed as approved drugs, which your doctor can prescribed for you without explaining why you need the drug. If you need a medication that is not included on the formulary, your doctor may have to explain why you need that medication, and why similar medications on the formulary will not work. Your doctor may want to consult our Provider page, which offers some advice on writing letters of medical necessity.

If you have prescription coverage through Medical Assistance but have been denied coverage for the drug your doctor prescribed, you can appeal the decision. If you are part of a Medical Assistance managed care organization, you can appeal using the internal grievance process. If you have Medical Assistance but do not have a managed care organization, you can appeal with the county assistance office and file a fair hearing. For more information on appealing, see our Complaints and Grievances page.

If you are covered by a private insurance company and are having trouble getting coverage for the drugs your doctor prescribes, you may also have appeal rights. Check your member handbook and call your insurance company's member services for assistance.