Program Terms and Conditions

Eligibility and Assistance

TAHF provides charitable financial assistance to eligible patients who meet the requirements of the Autoimmune & Inflammatory Disease Fund.

To qualify, a patient must meet TAHF’s current eligibility requirements, which include Medicare Part D coverage, an eligible diagnosis, an eligible provider-administered medication, applicable household-income requirements, and any required documentation or attestations.

Eligibility is determined independently by TAHF based on the information and documentation submitted and the requirements in effect at the time of review.

Submitting an application does not guarantee approval or assistance.

Approved patients may receive assistance up to the amount established by TAHF for the applicable program year. Assistance may be used only for qualifying out-of-pocket costs associated with an eligible medication and is not paid directly to the patient.

Accuracy of Information and Continuing Eligibility

The patient certifies that all information provided to TAHF by or on the patient’s behalf is true, complete, and accurate to the best of the patient’s knowledge.

The patient must promptly notify TAHF of a material change that could affect eligibility or administration of assistance, including a change in:

• insurance coverage;
• prescribed medication;
• diagnosis;
• household size or income; or
• other financial assistance applicable to the same expense.

TAHF may request additional information or documentation and may independently verify information submitted in connection with an application, award, or claim.

If TAHF determines that a patient no longer meets program requirements, or that materially inaccurate, incomplete, misleading, or fraudulent information was submitted, TAHF may deny, suspend, or terminate assistance.

Eligible Medications and Expenses

Assistance is limited to qualifying patient-responsibility amounts associated with an eligible provider-administered medication prescribed for an eligible diagnosis.

Approval for one medication does not constitute approval for another medication.

If the patient’s prescribed medication changes, TAHF may require additional information and must determine whether the new medication remains eligible under the Fund before assistance may be used for that medication.

TAHF will not pay more than the patient’s qualifying financial responsibility or remaining approved award balance.

TAHF will not knowingly provide assistance for an expense that has already been paid, reimbursed, or otherwise satisfied by another source.

Use of an Award

An award is provided solely for the benefit of the approved patient and may not be transferred, assigned, exchanged for cash, or used for an ineligible expense.

An approved patient must have a first eligible claim within 60 days of the award approval date. If no eligible claim is received within that period, TAHF may release the unused award and make those funds available to other eligible patients.

Following a timely first eligible claim, any remaining award balance may be used for eligible expenses through the end of the applicable program year, subject to continued eligibility and program requirements.

Unused award amounts do not represent funds owed to the patient and do not automatically carry forward into a future program year.

Claims and Requests for Assistance

Each claim or request for payment submitted by or on behalf of a patient constitutes a continuing certification that:

• information submitted to TAHF remains materially accurate and complete;
• the patient continues to meet applicable eligibility requirements;
• the claim relates to an eligible medication and qualifying expense;
• the amount submitted represents an actual patient financial responsibility; and
• the same expense has not already been paid or reimbursed by another source.

TAHF may request documentation or other information reasonably necessary to verify a claim before payment.

Patient Choice and TAHF Independence

TAHF does not determine which medication or treatment a patient should receive. Medical decisions are made by the patient and the patient’s healthcare provider.

TAHF does not condition eligibility on the use of a particular physician, clinic, pharmacy, manufacturer, or referral source.

However, the patient’s diagnosis, prescribed medication, insurance coverage, and requested expense must satisfy TAHF’s eligibility requirements.

TAHF independently establishes its eligibility criteria and makes all patient-assistance decisions.

Donors and other outside organizations may not select individual patients for assistance or direct TAHF to approve, deny, or prioritize a particular patient.

Information Used to Administer Assistance

The patient authorizes TAHF and its authorized service providers to obtain, use, and exchange information reasonably necessary to evaluate eligibility, administer assistance, process eligible payments, verify information, resolve discrepancies, prevent duplicate payment or misuse, and perform appropriate program and compliance activities.

As necessary for these purposes, information may be exchanged with the patient’s healthcare providers, pharmacies, insurer or prescription drug plan, authorized representatives, and organizations assisting TAHF with program administration.

TAHF may use aggregated or de-identified program information for operational, compliance, evaluation, reporting, and fundraising purposes.

Additional information about how TAHF collects, uses, and protects information is available in the TAHF Privacy Policy.

Medical Disclaimer

TAHF provides financial assistance only.

TAHF does not provide medical advice, prescribe treatment, determine medical necessity, or represent that any medication or treatment is safe, effective, or appropriate for a particular patient.

All decisions regarding diagnosis, treatment, medication, dosage, site of care, and other medical matters remain between the patient and the patient’s healthcare provider.

Funding and Program Administration

TAHF assistance is subject to available charitable funding.

TAHF may open, close, suspend, or discontinue a Fund, establish a waitlist, or modify program requirements when necessary based on available funding, regulatory requirements, or program needs.

Approval of an award does not guarantee payment of every submitted expense. Payment remains subject to continued eligibility, the eligibility of the expense, the patient’s available award balance, required documentation, and applicable program requirements.