Pediatric Assistance Fund

Status

Closed
Closed Funds

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.

Fund Type

Copay

Maximum Award Level

$2,500

Pharmacy Card Fund

Yes

Minimum Copay
Reimbursement Amount

Minimum Copay Reimbursement Amount

We encourage you to please use your HealthWell pharmacy card for any applicable charges as possible.

None

Minimum Premium
Reimbursement Amount

Minimum Premium Reimbursement Amount

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

None

Household Income Limit

500% of the Federal Poverty Level
(adjusted for household size and high
cost of living areas)

Fund Alerts

Sign up for email or text/call alerts to receive instant notifications.

Treatments Covered

  • Abilify
  • Abilify Mycite Maintenance Kit
  • Abilify Mycite Starter Kit
  • Acarbose
  • Adasuve
  • Adderall Xr
  • Adempas
  • Admelog
  • Admelog Solostar Pen
  • Adriamycin
  • Alkindi Sprinkle
  • Amantadine Hcl
  • Amantadine Hcl Avpak
  • Ambrisentan
  • Apidra
  • Apidra Solostar
  • Aptensio Xr
  • Aripiprazole
  • Aristada
  • Aristada Initio
  • Arranon
  • Asparlas
  • Baqsimi
  • Basaglar Kwikpen
  • Basaglar Tempo Pen
  • Betamethasone
  • Blincyto
  • Bortezomib
  • Bosentan
  • Byetta 10mcg Pen
  • Byetta 5mcg Pen
  • Carboplatin
  • Catapres-tts-1
  • Celestone Soluspan
  • Chlorpromazine Hcl
  • Chlorpromazine Hcl Avpak
  • Clofarabine
  • Clonidine
  • Clonidine Hcl
  • Concerta
  • Cortef
  • Cortisone Acetate
  • Cotempla Xr-odt
  • Cyclophosphamide
  • Cyclophosphamide Novaplus
  • Cytarabine
  • Darzalex
  • Daytrana
  • Decadron
  • Depo-medrol
  • Dexabliss 11-day Dose Pack
  • Dexamethasone
  • Dexamethasone Intensol
  • Dexamethasone Micronized
  • Dexamethasone Sodium Phosphate
  • Dexrazoxane
  • Dextenza
  • Dexycu
  • Dilantin
  • Doxorubicin Hcl Novaplus
  • Duraclon
  • Escitalopram
  • Etopophos
  • Etoposide
  • Etoposide Novaplus
  • Farxiga
  • Fiasp
  • Fiasp Flextouch
  • Fiasp Penfill
  • Fludarabine Phosphate
  • Fludarabine Phosphate Novaplus
  • Fluoxetine
  • Focalin
  • Forfivo Xl
  • Fusilev
  • Geodon
  • Gleevac
  • Glucagon
  • Glucagon Emergency Kit
  • Glumetza
  • Gocovri
  • Guanfacine Hcl
  • Guanfacine Hcl Avpak
  • Haloperidol
  • Haloperidol Decanoate Novaplus
  • Haloperidol Lactate
  • Hemady
  • Hemangeol
  • Hidex
  • Humalog
  • Humalog Junior Kwikpen
  • Humalog Kwikpen
  • Humalog Mix 50/50
  • Humalog Mix 50/50 Kwikpen
  • Humalog Mix 75/25
  • Humalog Mix 75/25 Kwikpen
  • Humalog Tempo Pen
  • Humulin 70/30
  • Humulin 70/30 Kwikpen
  • Humulin N (nph)
  • Humulin R
  • Humunlin N (nph) Kwikpen
  • Hydrocortisone
  • Hydrocortisone Avpak
  • Ibuprofen
  • Iclusig
  • Idamycin Pfs
  • Idarubicin Hydrochloride
  • Ifex
  • Ifosfamide
  • Imatinib Mesylate
  • Inderal La
  • Inderal Xl
  • Indocin
  • Indomethacin
  • Innopran Xl
  • Inomax
  • Insulin Aspart Flexpen
  • Insulin Aspart Penfill
  • Insulin Degludec
  • Insulin Degludec Flextouch Pen
  • Insulin Glargine
  • Insulin Glargine Pen
  • Intuniv
  • Invega
  • Invega Sustenna
  • Invega Trinza
  • Jakafi
  • Jardiance
  • Kenalog-10
  • Kenalog-40
  • Khapzory
  • Kymriah
  • Lantus
  • Letairis
  • Leucovorin Calcium
  • Levemir
  • Levemir Flexpen
  • Lexapro
  • Lithobid
  • Loxapine
  • Lyumjev Kwikpen U-100
  • Lyumjev Kwikpen U-200
  • Lyumjev Tempo Pen
  • Lyumjev U-100
  • Maxidex
  • Medrol
  • Medrol Dosepak
  • Mercaptopurine
  • Mesna
  • Mesnex
  • Metadate Cd
  • Metadate Er
  • Metformin Hcl
  • Metformin Hcl Avpak
  • Methotrexate
  • Methotrexate Avpak
  • Methotrexate Novaplus
  • Methotrexate Sodium
  • Methylin
  • Methylphenidate
  • Methylprednisolone
  • Methylprednisolone Acetate
  • Millipred
  • Mitoxantrone Hcl
  • Modafinil
  • Myxredlin
  • Nexiclon Xr
  • Novolin 70/30
  • Novolin 70/30 Flexpen
  • Novolin N (nph)
  • Novolin N Flexpen
  • Novolin R
  • Novolin R Flexpen
  • Novolog
  • Novolog Flexpen
  • Novolog Mix 70/30
  • Novolog Mix 70/30 Flexpen
  • Olanzapine
  • Olanzapine Avpak
  • Oncaspar
  • Opsumit
  • Orapred Odt
  • Orenitram
  • Osmolex Er
  • Otrexup
  • Ozurdex
  • Pamelor
  • Paraplatin
  • Pediapred
  • Perseris
  • Pimozide
  • Precose
  • Prednisolone
  • Prednisolone Anhydrous
  • Prednisolone Micronized
  • Prednisolone Sodium Phosphate
  • Prednisone
  • Prednisone Anhydrous
  • Prednisone Intensol
  • Premierpro Rx Cyclophosphamide
  • Premierpro Rx Doxorubicin Hcl
  • Premierpro Rx Geodon
  • Premierpro Rx Haloperidol Decanoate
  • Premierpro Rx Olanzapine
  • Provigil
  • Prozac
  • Purixan
  • Qelbree
  • Quillichew Er
  • Rasuvo
  • Rayos
  • Relexxii
  • Relion Novolin 70/30
  • Relion Novolin 70/30 Flexpen
  • Relion Novolin N Flexpen
  • Relion Novolin R
  • Relion Novolin R Flexpen
  • Relion Novolog
  • Relion Novolog Flexpen
  • Relion Novolog Mix 70/30
  • Relion Novolog Mix 70/30 Flexpen
  • Remodulin
  • Revatio
  • Rezvoglar Kwikpen
  • Riabni
  • Riomet
  • Riomet Er
  • Risperdal
  • Risperdal Consta
  • Risperidone
  • Risperidone M-tab
  • Risperidone Odt
  • Ritalin
  • Ritalin La
  • Rituxan
  • Ruxience
  • Rykindo
  • Saxenda
  • Semglee
  • Semglee Pen
  • Seroquel
  • Seroquel Xr
  • Sildenafil Citrate
  • Simplist Haloperidol
  • Solu-cortef
  • Sprycel
  • Strattera
  • Synjardy
  • Synjardy Xr
  • Tabloid
  • Taperdex
  • Taperdex 6-day
  • Taperdex 7-day
  • Tasigna
  • Thioguanine
  • Totect
  • Toujeo 1.5ml Prefilled Pen
  • Toujeo Max 3ml Prefilled Pen
  • Tracleer
  • Treprostinil
  • Tresiba
  • Tresiba Flextouch Pen
  • Trexall
  • Triamcinolone Acetonide
  • Triesence
  • Trulicity
  • Truxima
  • Tyvaso
  • Uptravi
  • Uzedy
  • Velcade
  • Venclexta
  • Venlafaxine
  • Veripred 20
  • Viagra
  • Victoza
  • Vincristine Sulfate
  • Vp-16
  • Vyvanse
  • Wellbutrin Sr
  • Wellbutrin Xl
  • Xatmep
  • Xigduo Xr
  • Zcort 7-day
  • Zilretta
  • Ziprasidone Hcl
  • Ziprasidone Hcl Avpak
  • Ziprasidone Mesylate
  • Zyprexa
  • Zyprexa Intramuscular
  • Zyprexa Zydis
Acute Lymphoid Leukemia
  • Amerinet Choice Carboplatin
  • Asparaginase Erwinia Chrysanthemi*
  • Besponsa
  • Betamethasone Acetate-betamethasone Sodium Phosph
  • Betamethasone Sod Phos-betamethasone Ace Novaplus
  • Betamethasone Sodium Phosphate-betamethasone Ace
  • Carboplatin N+ Novaplus
  • Carboplatin Novaplus
  • Clolar Novaplus
  • Cyclophosphamide Monohydrate
  • Daunorubicin Hcl
  • Daunorubicine Hcl Novaplus
  • Depo-medrol Novaplus
  • Dexamethasone Sodium Phosphate Novaplus
  • Dexamethasonetherapy Pack
  • Dexevo
  • Dexonto
  • Dexrazoxane Novaplus
  • Doxorubicin Hcl
  • Erwinase*
  • Idarubicin Hcl Novaplus
  • Ifosfamide Novaplus
  • Jylamvo
  • Kenalog-80
  • Leucovorin Calcium Novaplus
  • Levoleucovorin Calcium
  • Mercaptopurine Monohydrate
  • Mesna Novaplus
  • Methylprednisolone Acetate Novaplus
  • Nelarabine
  • Nelarabine Novaplus
  • Premier Pro Rx Betamethasone Na Phos-betameth Ace
  • Premierpro Rx Carboplatin
  • Premierpro Rx Dexamethasone Sodium Phosphate
  • Premierpro Rx Leucovorin Calcium
  • Premierpro Rx Mesna
  • Premierpro Rx Methotrexate
  • Premierpro Rx Methylprednisolone Acetate
  • Premierpro Rx Triamcinolone Acetonide
  • Pro-c-dure 5 Kit
  • Pro-c-dure 6 Kit
  • Readysharp Betamethasone
  • Rylaze
  • Simplist Dexamethasone Sodium Phosphate
  • Simplist Dexamethasone Sodium Phosphate +rfid
  • Solu-cortef 100mg Vial
  • Solu-cortef 250mg Vial
  • Solu-cortef 500mg Vial
  • Teniposide*
  • Triamcinolone Acetonide Novaplus
  • Venclexta Starter Pack
  • Vincristine Sulfate Novaplus
Autism Spectrum Disorder (including ADD and ADHD)
  • Abilify Asimtufii
  • Abilify Maintena Dual-chambered Syringe
  • Abilify Maintena Vial
  • Adderall
  • Adzenys Xr Odt
  • Amphetamine Salt Combination
  • Amphetamine Sulfate
  • Anafranil
  • Aripiprazole Avpak
  • Atomoxetine Avpak
  • Atomoxetine Hydrochloride
  • Azstarys
  • Behavioral Therapy Services*
  • Bupropion Hcl
  • Bupropion Hcl Avpak
  • Bupropion Hcl Xl
  • Bupropion Hydrochloride Sr
  • Catapress-tts-2
  • Catapress-tts-3
  • Clomipramine Hcl
  • Clonidine Hcl Avpak
  • Counseling Services*
  • Desipramine Hcl
  • Dexedrine Spansule
  • Dexmethylphenidate Hcl
  • Dexmethylphenidate/serdexmethylphenidate*
  • Dextroamph Sacc-amph Asp-dextroam Sulf-amphet Sulf
  • Dextroamphetamine Sulfate
  • Dyanavel Xr
  • Effexor Xr
  • Escitalopram Oxalate
  • Evekeo
  • Fluoxetine Hcl
  • Focalin Xr
  • Haldol Deconate
  • Haloperidol Amerinet Choice
  • Haloperidol Decanoate 50
  • Haloperidol Deconate
  • Imipramine Hcl
  • Imipramine Pamoate
  • Invega Hafyera
  • Jornay Pm
  • Lisdexamfetamine Dimesylate
  • Lithium
  • Lithium Carbonate
  • Lithium Citrate
  • Loxapine Succinate
  • Methamphetamine
  • Methamphetamine Hcl
  • Methylphenidate Hcl
  • Methylphenidate Hcl Avpak
  • Methylphenidate Hcl Cd
  • Methylphenidate Hcl La
  • Mixed Amphetamine Salt
  • Modafinil Avpak
  • Mydayis
  • Nortriptyline Hcl
  • Nortriptyline Hcl Avpak
  • Occupational Therapy Services*
  • Onyda Xr
  • Osmolex Er Dosing Kit
  • Paliperidone
  • Pemoline*
  • Physical Therapy Services*
  • Premierpro Rx Haldoperidol
  • Procentra
  • Quetiapine
  • Quetiapine Fumarate
  • Quetiapine Fumarate Avpak
  • Quillivant Xr
  • Seroquel Xr 14-day Sample Kit
  • Valproic Acid
  • Venlafaxine Hcl
  • Venlafaxine Hcl Avpak
  • Xelstrym
  • Zenzedi
Congenital Heart Disease
  • 7t Gummy Es
  • Acetaminophen (iv)
  • Acetaminophen Novaplus
  • Acetylsalicyclic Acid
  • Alprostadil
  • Arymo Er
  • Asprin
  • Caldolor
  • Caverject
  • Caverject Impulse
  • Cyklokapron
  • Dextrose/morphine Sulfate
  • Dilantin Infatabs
  • Dilantin-125
  • Duramorph
  • Durlaza
  • Edecrin
  • Edex
  • Ethacrynic Acid
  • Ibu
  • Ibuprofen Lysine
  • Indomethacin Avpak
  • Indomethacin Novaplus
  • Infatabs Phenytoin
  • Infumorph 200
  • Infumorph 500
  • Kadian
  • Mitigo
  • Morphine Sulfate
  • Morphine Sulfate In 5% Dextrose
  • Morphine Sulfate-sodium Chloride
  • Morphine-dextrose
  • Morphine-sodium Chloride
  • Ms Contin
  • Muse
  • Neoprofen
  • Ofirmev
  • Orenitram Titration Kit Month 1
  • Orenitram Titration Kit Month 2
  • Orenitram Titration Kit Month 3
  • Phenytek
  • Phenytoin
  • Phenytoin Sodium
  • Phenytoin Sodium Extended
  • Phenytoin Sodium Extended Avpak
  • Phenytoin Sodium Novaplus
  • Premierpro Rx Acetaminophen
  • Premierpro Rx Indomethacin
  • Premierpro Rx Tranexamic Acid
  • Propanolol Hcl
  • Propranolol Hcl Avpak
  • Prostin Vr Pediatric
  • Prostin Vr Pediatric Novaplus
  • Sildenafil
  • Sildenafil Avpak
  • Simplist Morphine Sulfate Microvault
  • Tivorbex
  • Tranexamic Acid
  • Tranexamic Acid Avpak
  • Tranexamic Acid Novaplus
  • Tranexamic Acid-sodium Chloride
  • Tyvaso Dpi
  • Tyvaso Dpi Institutional Kit
  • Tyvaso Dpi Titration Kit
  • Xarelto
  • Xarelto Starter Pack
Convergence Insufficiency
  • Prescription Frames For Glasses*
  • Prescription Lenses For Glasses*
Diabetes (Types I and II)
  • Bd Dextrose
  • Bydureon Bcise
  • Dapagliflozin Propanediol
  • Dapagliflozin Propanediol-metformin Hcl
  • Dextrose
  • Dextrose Anyhydrous
  • Dextrose Monohydrate
  • Dm2
  • Fiasp Pumpcart
  • Glucagen
  • Glucagen Diagnostic Kit
  • Glucagon Novaplus
  • Glucophage
  • Glucophage Xr
  • Gvoke Hypopen 1 Pack
  • Gvoke Hypopen 2 Pack
  • Gvoke Kit
  • Gvoke Pfs 1 Pack
  • Gvoke Pfs 2 Pack
  • Humulin R Concentrated U-500
  • Humulin R Concentrated U-500 Kwikpen
  • Insulin Aspart
  • Insulin Aspart Prot-insulin Aspart 70/30 Flexpen
  • Insulin Aspart Protamine/insulin Aspart 70/30
  • Insulin Aspart/insulin Aspart Protamine
  • Insulin Glargine U-300 Max Solostar
  • Insulin Glargine U-300 Solostar
  • Insulin Human Regular/insulin Human Isophane (nph)*
  • Insulin Lispro
  • Insulin Lispro Junior Kwikpen
  • Insulin Lispro Kwikpen
  • Insulin Lispro Protamine/ins Lispro 75/25 Kwikpen
  • Insulin Lispro/insulin Lispro Protamine
  • Lantus Solostar Pen
  • Liraglutide
  • Metformin Hydrochloride
  • Metformin/dapagliflozin
  • Metformin/empagliflozin
  • Tzield
  • Zegalogue

Fund Definition

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).

Grant Utilization

HealthWell estimates that patients use an average of $1,500 during their 12-month grant period for this disease area.

Do I Qualify?

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:

  • 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/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.

  • 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.

  • 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.

  • 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).

About HealthWell’s Pediatric Assistance Fund

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.

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