Reimbursement and Billing
Fulcrum is enrolled as a provider for Delaware and Pennsylvania Medicaid, all Delaware Managed Care Organizations (MCOs) as well as a variety of third-party payers. Our highly skilled reimbursement specialists increase efficiency and cost effectiveness for our facilities and clients. As a leading provider of pharmacy services to the special needs community, Fulcrum is committed to offering those we serve with the latest information regarding Medicare Part D, and direct assistance programs, to ensure that they are used to the fullest.
At Fulcrum Pharmacy, we strive to provide accessible healthcare solutions for all our valued customers. We are excited to announce our new Medicaid/Medicare Direct Billing service, designed to simplify your pharmacy experience and ensure seamless access to vital medications and healthcare products.
Financial Assistance FAQ
What Types of financial assistance programs are available form prescription?
There are various types of financial assistance programs available for specialty prescriptions. Eligible patients can utilize manufacturer/copay/discount programs or patient assistance programs to lower their out-of-pocket costs.
What is a manufacturer / copay / discount program?
A manufacturer/copay/discount program is a form of financial assistance
offered by drug manufacturers to offset the patients copay or out-of-pocket costs. It is primarily used for brand name drugs and cannot be used for prescriptions covered by Medicare, Medicaid, or any federal/state funded program. These programs are often used for marketing purposes.
What are patient assistance programs?
Patient assistance programs offer financial assistance to uninsured,
underinsured, and government-funded patients. They can be provided by non-profit organizations or for-profit businesses and have specific qualifying criteria such as income, dependencies, and coverage for select medications. Patients need to apply yearly for funds and must stay compliant in taking their medications to continue receiving funding.
What is the process for obtaining financial assistance for my prescription?
To determine if you are eligible for financial assistance for prescriptions, call 877-658-8020 to speak with a specialist who will provide information specific to your situation. Eligibility will be determined through a series of questions, and if eligible, the patient will be enrolled and provided with additional information needed to receive the discount.
If I have Medicare or Medicaid am I eligible for any financial assistance?
Patients with Medicare/Medicaid may still be eligible for financial assistance to lower their out-of-pocket costs on some prescriptions. However, they are not eligible for manufacturer discount programs.
What information is needed to lower my out-of-pocket costs?
To lower out-of-pocket costs, patients may not need extensive personal
information but may be asked specific questions related to demographics and income. Supporting documents may be required for the application process, and we may work with the prescriber to obtain any necessary forms. Some patient assistance programs may require W2 or tax information, and failure to provide required information could result in the loss of funding.