INTAKE
• Intake form – data needed for application• Income Eligibility - Checklist of documentation
needed – Tax return or sign form 4506T– 1 month’s pay stubs– Copies of unemployment benefits, pensions, Social
Security and other income
• Prescriptions – Physician’s signed prescription must be sent to PAP– Physician office may send med list. TPC software
generates prescriptions for MD to sign.
Application for Each Medicine
● The patient signs a computer generated application form for each medicine.
Working with the Physician
• The MAP works closely with physician office regarding ordering and receipt of medicines.
• The physician signs the application form, and mails application OR
• The physician signs the form and returns it to the Caseworker to mail.
Shipment of Meds and Dispensing● Medicines arrive 2-4 weeks later at
doctor’s office or clinic; some may be mailed directly to the patient.
● Local pharmacies may receive meds for dispensing to patients.
Bridge Medicines
• Bridge medicines fill the time lag gap
• Samples dispensed at clinic or MD office
• Generic medicines may be prescribed for interim use .
• Vouchers may be used to pay for medicine until free supply arrives.