County to improve access to MedAssist: relief from the high cost of life-saving drugs

SAN JOSE - MedAssist, Santa Clara County’s “first-in-the-nation” program to help cover the cost of prescription medications for diabetes, asthma, and severe allergies, will have a streamlined application process and increased enrollment in 2025, according to a recent update at the County’s Health and Hospital Committee (HHC) meeting.

The updated application process ensures that grant funds are allocated to County residents who fall in the “missing middle” of health care — individuals who may be enrolled in a health insurance program but are forced to pay high out-of-pocket costs for their life-saving medications.

“Insulin, inhalers, and EpiPens are not ‘nice’ to have medications; they’re ‘must’ haves. As Chair of the County’s Health and Hospital Committee, I know that they cost too much,” said County Supervisor Joe Simitian, who proposed and championed the MedAssist program, which launched in 2022.

“I’m so appreciative of all the work that has gone into this vital program that offers real, easy-to-access relief for our residents,” said Simitian when accepting the MedAssist program update at the year’s final HHC meeting. “I hope it has the resources it needs to keep growing in the future.”

In Santa Clara County an estimated 135,000 adults have been diagnosed with diabetes, more than 250,000 adults and children with asthma, and more than 20,000 individuals are prescribed epinephrine auto-injectors for allergic reactions. MedAssist offers monthly grants to qualified residents to offset the cost of anti-diabetics (including insulin), asthma inhalers, and epinephrine auto-injectors.

“Diabetes, asthma, and severe allergies are chronic, lifelong, and common conditions that can be well managed with proper treatment,” Simitian said. “No one should have to break the bank in order to afford that treatment — or go without, with potentially catastrophic consequences.”

MedAssist was specifically designed to support the many County residents who fall into what Simitian calls the “missing middle” — those earning too much to qualify for most government programs, but not enough to afford first-rate insurance or out-of-pocket costs.  Even when drugs are “covered” by health insurance, they may not be affordable, Simitian said.

In 2024, MedAssist hit a new milestone, with 2,000 residents enrolled and receiving grants. The target for 2025 is 2,500 enrollees.

To achieve that goal, the program will launch an awareness campaign with an updated website and forms available in eight languages: English, Spanish, Vietnamese, Traditional Chinese, Simplified Chinese, Tagalog, Farsi, and Punjabi. Grant amounts are to be used specifically to purchase qualifying medications, and will be based on out-of-pocket healthcare expenditures for the qualifying medications and a household cap.

MedAssist eligibility criteria for adults and children living in Santa Clara County includes:

• Having a valid prescription for diabetes medications, asthma inhalers, or epinephrine auto-injectors (EpiPens);
• Meeting annual household gross income limit requirements, not to exceed 650% of the Federal Poverty Level;
• Meeting the individual out-of-pocket healthcare spending requirements;
• Is currently not receiving prescription drug coverage or support from a federal health care program or a state health care program such as: Medi-Cal (including Managed Care Medi-Cal, such as Santa Clara Family Health Plan and Blue Cross/Blue Sheild, as well as Medi-Cal Fee-for-Service), Medicare (including Medicare Part D and Medicare Advantage Prescription Drug Plans), TRICARE, VA Health Administration, Indian Health Service, and Children’s Health Insurance Program (CHIP).

Applications for the MedAssist 2025 program year will be accepted starting January 1, 2025. For more information: www.getmedassist.com.