The HealthWell Pediatric Assistance Fund

The HealthWell Pediatric Assistance Fund is sponsored by HealthWell Foundation. This opportunity supports mission-aligned projects and measurable outcomes.

Pediatric Assistance Fund - HealthWell Foundation This fund is temporarily closed to new patients due to lack of sufficient funding. Please continue to visit our Disease Funds page often, as replenished funds reopen as quickly as possible. If you currently have a grant with HealthWell, your grant will remain active for the entire 12 month grant cycle or until you have exhausted your allocated grant amount, whichever comes first.

You can continue to use your pharmacy card or submit requests for reimbursements during your designated grant cycle. Minimum Copay Reimbursement Amount Minimum Copay Reimbursement Amount help Minimum Copay Reimbursement Amount We encourage you to please use your HealthWell pharmacy card for any applicable charges as possible.

Minimum Premium Reimbursement Amount Minimum Premium Reimbursement Amount help Minimum Premium Reimbursement Amount We encourage you to please submit monthly reimbursement claims (even if your premium is paid on a bi-weekly basis).

500% of the Federal Poverty Level (adjusted for household size and high cost of living areas) Transportation - Car Mileage Amerinet Choice Carboplatin Asparaginase Erwinia Chrysanthemi Recombinant-rywn Asparaginase Erwinia Chrysanthemi* Betamethasone Acetate-betamethasone Sodium Phosph Betamethasone Sod Phos-betamethasone Ace Novaplus Betamethasone Sodium Phosphate-betamethasone Ace Cyclophosphamide Monohydrate Cyclophosphamide Novaplus Daunorubicine Hcl Novaplus Dexabliss 11-day Dose Pack Dexamethasone Sodium Phosphate Dexamethasone Sodium Phosphate Novaplus Dexamethasonetherapy Pack Fludarabine Phosphate Novaplus Hydrocortisone Sodium Succinate Leucovorin Calcium Novaplus Mercaptopurine Monohydrate Methylprednisolone Acetate Methylprednisolone Acetate Novaplus Methylprednisolone Sodium Succinate Prednisolone Sodium Phosphate Premier Pro Rx Betamethasone Na Phos-betameth Ace Premierpro Rx Carboplatin Premierpro Rx Cyclophosphamide Premierpro Rx Dexamethasone Sodium Phosphate Premierpro Rx Doxorubicin Hcl Premierpro Rx Leucovorin Calcium Premierpro Rx Methotrexate Premierpro Rx Methylprednisolone Acetate Premierpro Rx Triamcinolone Acetonide Simplist Dexamethasone Sodium Phosphate Simplist Dexamethasone Sodium Phosphate +rfid Triamcinolone Acetonide Novaplus Vincristine Sulfate Liposome Vincristine Sulfate Novaplus Autism Spectrum Disorder (including ADD and ADHD) Abilify Maintena Dual-chambered Syringe Abilify Mycite Maintenance Kit Abilify Mycite Starter Kit Atomoxetine Hydrochloride Behavioral Therapy Services* Bupropion Hydrochloride Sr Dexmethylphenidate And Serdexmethylphenidate Dextroamphetamine Sulfate Haloperidol Decanoate Novaplus Lisdexamfetamine Dimesylate Methylphenidate Hcl Avpak Occupational Therapy Services* Physical Therapy Services* Premierpro Rx Haldoperidol Premierpro Rx Haloperidol Decanoate Quetiapine Fumarate Avpak Dextrose/morphine Sulfate Morphine Sulfate In 5% Dextrose Morphine Sulfate-sodium Chloride Orenitram Titration Kit Month 1 Orenitram Titration Kit Month 2 Orenitram Titration Kit Month 3 Phenytoin Sodium Extended Phenytoin Sodium Extended Avpak Phenytoin Sodium Novaplus Premierpro Rx Acetaminophen Premierpro Rx Indomethacin Premierpro Rx Tranexamic Acid Propranolol Hydrochloride Avpak Prostin Vr Pediatric Novaplus Simplist Morphine Sulfate Microvault Tranexamic Acid-sodium Chloride Tyvaso Dpi Institutional Kit Convergence Insufficiency Prescription Frames For Glasses* Prescription Lenses For Glasses* Diabetes (Types I and II) Canagliflozin And Metformin Hydrochloride Dapagliflozin Propanediol Dapagliflozin Propanediol And Metformin Hcl Empagliflozin And Metformin Hydrochoride Humalog Mix 50/50 Kwikpen Humalog Mix 75/25 Kwikpen Humulin R Concentrated U-500 Humulin R Concentrated U-500 Kwikpen Insulin Aspart Prot-insulin Aspart 70/30 Flexpen Insulin Aspart Protamine-insulin Aspart 70/30 Insulin Aspart-szjj, Recombinant Insulin Aspart/insulin Aspart Protamine Insulin Degludec Flextouch Pen Insulin Glargine U-300 Max Solostar Insulin Glargine U-300 Solostar Insulin Glargine-aglr, Recombinant Insulin Glargine-yfgn Pen Insulin Human Isophane (nph) Insulin Human Regular And Insulin Human Isophane (nph) Insulin Lispro And Insulin Lispro Protamine Insulin Lispro Junior Kwikpen Insulin Lispro Protamine And Ins Lispro 75/25 Kwikpen Insulin Lispro-aabc Recombinant Novolog Mix 70/30 Flexpen Relion Novolin 70/30 Flexpen Relion Novolog Mix 70/30 Flexpen Toujeo 1.

5ml Prefilled Pen Toujeo Max 3ml Prefilled Pen *These products are not billable through HealthWell’s pharmacy card. Please submit requests for reimbursement through our paper claim process.

Assistance with the cost shares of prescription drugs, therapies, devices, and transportation related to eligible disease states (Acute Lymphoid Leukemia, Autism Spectrum Disorder (including ADD and ADHD), Congenital Heart Disease, Convergence Insufficiency, Diabetes (Types I and II). HealthWell estimates that patients use an average of $1,500 during their 12-month grant period for this disease area.

HealthWell bases eligibility on an individual’s medical, financial and insurance situation. To qualify for HealthWell’s assistance, applicants must meet the following eligibility requirements: Your child is being treated for one of the disease/disorder areas covered by this fund.

To find out if you are eligible for HealthWell’s Pediatric Assistance Fund, please contact us at (800) 675-8416 to speak with a HealthWell representative or apply online. We can only assist with medications that have been prescribed to treat the disease/disorder covered diagnosis.

You will be asked to provide the Foundation with the patient’s diagnosis, which must be verified by a physician, nurse practitioner, or physician assistant’s signature. The patient must receive treatment in the United States. You have insurance and it covers your medication.

To qualify for assistance from HealthWell, you must have some form of health insurance (private insurance, Medicare, Medicaid, TriCare, etc.) that covers part of the cost of your treatment. The Foundation will refer patients without prescription insurance to other programs, such as manufacturer patient assistance programs. Your income falls within our guidelines.

HealthWell assists individuals with incomes up to 300-500% of the Federal Poverty Level . The Foundation also considers the number in a household and cost of living in a particular city or state. If you believe you qualify for assistance, please call (800) 675-8416 to speak with a HealthWell representative.

You are receiving treatment in the United States. If you are receiving treatment in the U.S. and have met the eligibility criteria as listed, you are ready to apply! Please note that you will be asked to provide a Social Security Number in order to create a grant.

This information is gathered to eliminate duplicate applications and is kept secure and confidential. To apply for a grant through our Pediatric Assistance Fund, you can contact a HealthWell representative at 1-800-675-8416 or apply online. We wish we could say “yes” to every family that comes to us, however, funding is limited.

Families must meet HealthWell’s standard income and insurance eligibility criteria to qualify for a grant. Grants are awarded through the Pediatric Assistance Fund. To apply for a grant, call 1-800-675-8416 anytime Monday through Friday, 9:00 a.

m. to 5:00 p. m.

(ET). HealthWell’s Pediatric Assistance Fund helps children access the medical treatments they need for specific diseases or conditions. Through the fund, HealthWell is able to assist families in meeting their cost-sharing obligations for conditions covered under the fund to help their child start or continue treatments they otherwise would not be able to afford.

You may also visit our Resource List to view other copayment organizations that may provide assistance. Change a child’s life. Give Today.

Additional Educational Resources African American Diabetes Association American Diabetes Association Children's Organ Transplant Association You may also visit our Resource List to view other copayment organizations that may provide assistance. Federal Poverty Level Calculator Your family size, including yourself: Your yearly income is % of the Federal Poverty Level. There was an error calculating your Federal Poverty Level.

Please check that your inputs are valid and try again. Our Federal Poverty Level (FPL) Calculator is for determining your eligibility for financial assistance programs offered by The HealthWell Foundation. Scan QR code or continue to Apple app store .

Scan QR code or continue to Google Play store . Dirección de correo electrónico (requerida) By submitting your email you agree to receive emails from the HealthWell Foundation and can opt-out at any time. Al enviar su correo electrónico, acepta recibir mensajes de HealthWell Foundation y puede optar por dejar de recibirlos en cualquier momento.

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