Our grant use policy
The PAN Foundation’s grant use policy requires patients, or their healthcare professional, to request and receive payment for a claim from the PAN Foundation every 120 days to keep the grant active.
Throughout the 12-month rolling eligibility period, claims can be reimbursed through pharmacy claims, medical claims, or direct reimbursement. Patients are notified of this policy at the time of grant approval and again after 90 days if we have not received a paid claim or transaction (for card supported funds). If we haven’t heard from them after 120 days, the grant is canceled and reallocated to support other people needing assistance. This policy allows PAN to use donations to efficiently help as many people as possible.
Learn more about our grant use policy.
How our claims and reimbursements work
All patients must be insured, the patient’s insurance must cover their medication, and the patient’s medication or product must be listed as a covered medication. If a healthcare professional does not submit a claim on behalf of the patient, the patient can pay the out-of-pocket costs themselves and then request reimbursement for approved expenses using a direct member reimbursement form.
Patient reimbursement requests can be submitted via the PAN Foundation portal, mail, or fax. We will not reimburse for:
- Medications or over-the-counter products not covered by your insurance
- Medications paid by the insurance payer at 100%
- Medications billed only to drug discount cards and not insurance
- Medical services, such as lab work, diagnostic testing, genetic testing, ER visits, and office visits
- Medications not covered under PAN’s formulary for the relevant disease fund
Provider and pharmacy claims can be submitted either electronically via billing software or manually using the PAN Foundation portal, mail, or fax. We contract with independent third-parties to process medical claims and pharmacy claims.
For more information on claims and reimbursement requests, review our submitting claims and reimbursements webpage.
How we use claims data
We collect data, including about claims, to help facilitate ongoing communications with people about their assistance at the PAN Foundation, as well as to monitor and optimize our services. This data isn’t released to anyone outside of the PAN Foundation and its vendors. We follow U.S. Department of Health and Human Services’ Office of Inspector General (OIG) and Health Insurance Portability & Accountability Act (HIPAA) rules and regulations. Safeguards, including mandatory training, are in place to ensure only appropriate staff have access to individual grant-level data.
We also collaborate with actuarial consultants to determine how many people need assistance across each disease fund. They use PAN Foundation-specific data, such as enrollment and claims information, other available claims data, and publicly available prevalence data, to estimate the expected need for support for all new disease funds. PAN reviews its claims data every month to make sure the grant amount adequately covers the out-of-pocket costs for most patients.
