Six of the most commonly prescribed expensive medications, and the income limit each manufacturer sets for its assistance programme. They are not the same — not even for drugs treating the same condition.
Assistance income limits by drug
| Drug | Treats | Threshold | 1 person | Family of 4 |
|---|---|---|---|---|
| Ozempic | type 2 diabetes | 200% | $31,920 | $66,000 |
| Jardiance | type 2 diabetes, heart failure | 200% | $31,920 | $66,000 |
| Eliquis | blood thinner | 300% | $47,880 | $99,000 |
| Enbrel | rheumatoid arthritis, psoriasis | 300% | $47,880 | $99,000 |
| Otezla | psoriasis, psoriatic arthritis | 300% | $47,880 | $99,000 |
| Cosentyx | psoriasis, psoriatic arthritis, AS | 400% | $63,840 | $132,000 |
| Biktarvy | HIV-1 | 500% | $79,800 | $165,000 |
| Trulicity | type 2 diabetes | 300% | $47,880 | $99,000 |
Four Thresholds Across Eight Drugs
The spread is the thing worth noticing. Ozempic and Jardiance sit at 200% of the federal poverty level — under $31,920 for one person. Biktarvy sits at 500%, under $79,800. That is a gap of nearly $47,880 in allowable income between two programmes on the same list.
Nothing about the medication explains it. The threshold is set by the manufacturer, as a matter of company policy, and manufacturers do not coordinate.
Same Condition, Different Answer
This is where it costs people money.
Ozempic and Trulicity both treat type 2 diabetes. Ozempic's programme stops at 200% of poverty; Trulicity's runs to 300%. A single person earning $40,000 is over the line for one and comfortably under it for the other.
Otezla and Cosentyx both treat psoriasis and psoriatic arthritis. Otezla is set at 300%, Cosentyx at 400%. Same conditions, a full band apart.
So being turned down for one drug tells you nothing about the next. If a prescriber has a clinical reason to consider an alternative anyway, the assistance threshold is worth raising in that conversation — but it is a conversation for them, not a reason to switch on your own.
The Ones Set Unusually Low
Ozempic and Jardiance are the tightest on this list at 200%. That matters because both are prescribed very widely, including to people whose income is nowhere near the line — a family of four qualifies only under $66,000.
Ozempic carries a second complication: insurers frequently cover it for diabetes and decline it for weight management. If that is why your claim was denied, the reason code will say so, and an appeal is often a faster route than an assistance application you may not qualify for on income. Reading the denial code is here.
The Ones Set Unusually High
Biktarvy at 500% is among the most generous thresholds anywhere on the list — up to $165,000 for a family of four. HIV medications cluster at that level, reflecting both their cost and a public-health interest in keeping people on continuous treatment.
If you were refused assistance for something else on income, do not assume the same answer applies here. There is also a separate federal programme for HIV medication assistance run through the states, worth asking about alongside the manufacturer route.
Before You Apply for Any of Them
Income is the headline test and not the only one. These programmes also require that you have no other way to pay — you are uninsured, or your plan does not cover the drug — and many exclude people on Medicare or Medicaid. Assistance is not insurance and does not count toward a deductible or out-of-pocket maximum.
The income figures above use the 2026 federal poverty guidelines: $15,960 for one person, plus $5,680 for each additional person. If you are also shopping marketplace coverage, note that premium tax credits for 2026 run on the prior year's guidelines, so those numbers will not match these. Both are correct; they are different tables. Do not use one to estimate the other.
Thresholds change and each manufacturer sets its own. The full list of 405 medications is here, and the limits by household size are here.
If you are on more than one of these and cannot work out which programmes you qualify for, call (713) 575-9904 and we will go through them.