Irene Adkins doesn’t know how she’s going to afford the drugs that keep her alive in 2018. The 59-year-old former building supervisor from Falls Church, Va., suffers from pulmonary hypertension, a rare lung disorder that can lead to fatal heart failure if left untreated. To keep the disease at bay she takes a few pills each day that, together, cost about $150,000 per year. While Adkins’s government-funded Medicare plan covers most of the cost, her out-of-pocket portion is about $10,000—a sum she can’t afford on her $1,600-a-month disability check.

Like hundreds of thousands of Medicare patients who can’t afford the copays on astronomically priced drugs, Adkins has turned to help from a fast-growing corner of the convoluted U.S. health system: patient assistance charities, which are funded almost entirely by drugmaker contributions and help Medicare patients with out-of-pocket expenses.

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