Financial Help & Copay Programs

Inflammatory bowel disease care can be expensive. Help exists from drug manufacturers, charitable foundations, and hospital programs. This guide explains who each program helps, how to apply, and how 2025 Medicare changes affect out‑of‑pocket costs. It also flags “copay accumulator” rules that can erase the benefit of copay cards and shows simple steps to find open funds fast. (crohnscolitisfoundation.org)

Key takeaways

• Manufacturer copay cards often drop costs to $0–$5 for those with commercial insurance, but they are usually not valid with Medicare or Medicaid. (rinvoq.com)

• Charitable foundations offer copay grants that open and close; sign up for FundFinder alerts to know when IBD funds reopen. (panfoundation.org)

• In 2025, Medicare Part D out‑of‑pocket drug costs are capped at $2,000, and a new monthly “Prescription Payment Plan” lets costs be spread across the year. (cms.gov)

• Copay “accumulator” policies may prevent copay card payments from counting toward deductibles; know your plan’s rules. (crohnscolitisfoundation.org)

• Hospital charity care and nonprofit tools can lower medical bills beyond medicines. (crohnscolitisfoundation.org)

Where to get help

1) Manufacturer programs

• Copay/savings cards: For people with commercial insurance, many brand‑name IBD medicines offer savings cards that can reduce out‑of‑pocket costs to as little as $0–$5 per fill or infusion, up to a yearly maximum. Examples include EntyvioConnect, J&J withMe (for Remicade and Stelara), and RINVOQ Complete. These programs generally exclude anyone using Medicare, Medicaid, TRICARE, or other government coverage. (entyvio.com)

• Patient assistance programs (PAPs): If uninsured or under‑insured, some companies provide medicine at no cost if income and other criteria are met. Examples include myAbbVie Assist, Pfizer RxPathways, and Lilly Cares. (abbvie.com)

What if insurance is delayed or changes mid‑year Many manufacturers offer temporary “bridge” or “start” programs to avoid treatment gaps while coverage is sorted. For instance, Entyvio lists a Start Program alongside copay and nurse support. Ask the product‑specific support line. (entyvio.com)

2) Independent charitable foundations

These nonprofits give time‑limited copay grants for specific diseases. Eligibility often includes a diagnosis, U.S. residency, insurance, and income within a set percentage of the federal poverty level (FPL). Funds open and close based on donations.

• PAN Foundation: Copay grants and a free FundFinder service that sends alerts when IBD funds across charities open. (panfoundation.org)

• Patient Advocate Foundation Co‑Pay Relief (PAF): Disease‑specific grants with online and phone enrollment. (patientadvocate.org)

• HealthWell Foundation: Copay and premium help for covered diagnoses, sometimes Medicare‑specific IBD funds; availability fluctuates. (healthwellfoundation.org)

• Good Days: Copay grants for various conditions when funding allows. Check current status. (crohnscolitisfoundation.org)

Tip: If a fund is closed, join its wait list and set FundFinder alerts. Apply the day a fund reopens; grants are often first‑come, first‑served. (panfoundation.org)

3) Other useful resources

• Medicine Assistance Tool (MAT.org): One search for many manufacturer assistance programs. (mat.org)

• NeedyMeds: Up‑to‑date listings of drug‑specific programs and a free pharmacy discount card. (cancerandcareers.org)

• Crohn’s Colitis Foundation: Curated lists of insurance and financial resources, including Dollar For for hospital charity care. (crohnscolitisfoundation.org)

2025 Medicare updates that matter for IBD

• Annual cap: Out‑of‑pocket costs for Part D‑covered drugs are capped at $2,000 in 2025. Once reached, no additional cost sharing applies that year. (cms.gov)

• Payment smoothing: The Medicare Prescription Payment Plan lets enrollees spread drug costs across monthly bills, which can be helpful early in the year. It does not lower the total you pay. Enroll through your plan. (medicare.gov)

• Copay cards: Manufacturer savings programs typically cannot be used with Medicare or Medicaid. Look to charitable foundations or manufacturer PAPs instead. (remicade.com)

Copay accumulators and maximizers

Some health plans use “accumulator” or “maximizer” policies. Payments made by a copay card may not count toward the deductible or out‑of‑pocket maximum, and some third parties may try to steer patients to extract more from copay programs. Ask the plan if copay assistance counts, and keep records. The Crohn’s Colitis Foundation offers plain‑language tools on navigating these policies. (crohnscolitisfoundation.org)

How to apply: a simple checklist

1) List your medicines, doses, and how they are billed (pharmacy vs infusion/medical benefit).
2) Gather documents: insurance card, income estimate, and prescriber details; some PAPs require proof of income. (abbvie.com)
3) Check manufacturer support for each drug, then search charities. Set FundFinder alerts. (panfoundation.org)
4) Ask the clinic nurse, pharmacist, or social worker to help submit forms. Many portals let providers enroll on your behalf. (healthwellfoundation.org)
5) If denied or a fund is closed, join wait lists, ask about bridge programs, and reapply when status changes. (panfoundation.org)

Quick comparison of common help options

Citations for the examples above: (entyvio.com)

FAQs

Do copay cards work with Medicare or Medicaid

Usually no. Federal program rules and manufacturer terms exclude government insurance from copay card use. Look into charitable foundations or manufacturer PAPs. (remicade.com)

How can someone know when an IBD copay fund opens

Create a free account at PAN’s FundFinder to get email or text alerts when disease funds at multiple charities open. Apply the same day. (panfoundation.org)

What if copay assistance is not counting toward the deductible

Plans with copay accumulator policies may not credit copay card payments. Ask the insurer about its policy, and use the Crohn’s Colitis Foundation tools for next steps. (crohnscolitisfoundation.org)

Where can families find help beyond medications

Use hospital financial assistance programs for medical bills and nonprofit tools like NeedyMeds and Dollar For, listed by the Crohn’s Colitis Foundation. (crohnscolitisfoundation.org)

Editor note: program names, amounts, and eligibility change frequently; always confirm current terms on the program’s website.