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What is the Patient Assistance Program (PAP)?

Pharmaceutical companies have their own requirements and forms to be signed. From experience, we know you may need our assistance in determining if you qualify and in completing the forms to apply for and to receive prescribed medication.

We have a team dedicate to connecting you and your prescribed medications with the Patient Assistance programs of the drug companies.

Patient Assistance

Patient Assistance is the term commonly used by drug companies to identify their programs for distributing their drugs free of charge to those who qualify. As a patient of Matthew 25, some medications which have been prescribed for you may be available through Patient Assistance. Our Patient Assistance team scans or photocopys documents requested by drug companies to participate in their Patient Assistance programs. We also assist in completing necessary forms that you are asked to complete.

Do I Qualify

Do I Qualify for
Patient Assistance?

Being a patient at Matthew 25 does not automatically qualify you for Patient Assistance. We will help you through the registration process. To begin, gather the required documents and contact us to schedule a time to fill out the appropriate forms to qualify for the Patient Assistance.

Utilize the Resources Available to You

Drug companies encourage you, the patient, to utilize the resources available to you.


If appropriate, applying for Medicaid IS EXPECTED.


We will provide the paper work needed and our Patient Advocate will assist you with understanding the process.




Until we receive verification that you have applied for Medicaid and that it is pending or bring in a Medicaid Denial Letter, we will continue the 15 day process. If you bring in a Medicaid Denial Letter, we can get the medication from the drug company.

Required Documentation
Signing a Contract

Required Documentation

Proof of Income

  • #4506 (IRS) form, if you filed taxes for the past year (or going to file this year) or #4506-T form (IRS) if not filing taxes this year

  • W-2 form until you bring in a copy of your taxes.

  • Pay stubs for a 4-week continuous period from all household members (within the last two months).

    If living with someone that is not financially responsible for you, provide letter so stating.

Additional Requirements if Applicable

  • Proof of Social Security income, Disability income, Unemployment income

  • Form, letter, check showing Pensions and/or Child Support

  • If you are not a citizen of the U.S. citizen, but a resident of the USA, we need to copy your Residency of the United States card.

We cannot process applications without showing each person’s unique financial situation. If you are not filing a tax return or are unemployed, we need to know so we can submit the appropriate information to the drug company’s representative. Please tell the Front Desk of any updates to your financial information since you were last seen at Matthew 25.

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