Patient assistance programs are a vital piece of the puzzle in helping patients navigate access to and afford their therapies. Data and analytics help inform when patient assistance may be needed for different programs or signal when it might be appropriate to reallocate resources elsewhere.
Full Answer
What is a patient assistance program (PAP)?
Patient assistance programs (PAPs) aim to bring lifesaving therapies to patients who need financial support. McKesson RxO and RxCrossroads by McKesson can support medication access across healthcare settings—and uncover hidden revenue for your organization.
What is an example of a drug assistance program?
For example, the manufacturer GlaxoSmithKline offers an assistance program for its medications Benlysta and Nucala. In their qualification section, they list what your maximum monthly gross income must be under, which is dependent on your household size and where you live. What are some examples of these programs?
How do I sign up for a medication assistance program?
To sign up, you will either call the program or register online. You will need to submit forms like your tax documents and proof of residence to prove your eligibility. Most programs also require your healthcare provider to fill out a form. Once you are enrolled, there may be limits on how much medication you can get or how long the program lasts.
What is drug assistance?
Who sponsors drug assistance programs?
Why are patients more likely to abandon their prescriptions at the pharmacy counter?
Can patients receive medication for little or no cost?
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Patient Assistance Programs - Frequently Asked Questions
What steps do you need to take? Yes. Although eligibility differs from program to program, they all have three specific criteria in common. Income: To qualify for any patient assistance program, your total household income must be less than 200% of the Federal Poverty Level. Prescription Coverage: Prescription assistance programs require that you do not currently subscribe to private or public ...
Patient Assistance Programs - Prescription Drugs for the Uninsured
Trisha Torrey is Every Patient's Advocate. She is a newspaper columnist, radio talk show host, national speaker, and the guide to patient empowerment at About.com.
Patient Assistance Programs & Prescription Assistance Programs
Discussion. There are several types of PAPs. There are ones that are designed for patients that do not have insurance, others for individuals whose insurance co-payment amounts are prohibitively expensive, and still other programs to assist with specific types of insurance, such as Medicare Part D.
What Are Patient Assistance Programs? - GoodRx
Patient assistance programs are usually sponsored by pharmaceutical companies and promoted as a safety net for those without health insurance. Learn how they work, their benefits and downsides, and how to find patient assistance programs for medications.
Patient Assistance Programs: The Good, the Bad, and the Ugly
We are all familiar with the patient assistance programs (PAPs) primarily sponsored by drug manufacturers or a partner organization and generally consider them a good thing for assisting patients with high out-of-pocket costs for expensive specialty drugs, especially in this era of high-deductible insurance plans.
What is a pharmacy?from npino.com
A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist.
What is loyalty script?from mckesson.com
Help patients overcome financial barriers to adherence with our trusted pharmacy co-pay support solution, LoyaltyScript®. LoyaltyScript helps tens of thousands of patients save money on their medications every day. It also offers multi-channel support, sending patients relevant messages based on actions or inactivity including:
What is the primary function of a pharmacy?from npino.com
A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. Mail Order Pharmacy.
What is a supplier in pharmacy?from npino.com
Definition. A pharmacy that dispenses generally low volume and high cost medicinal preparations to patients who are undergoing intensive therapies for illnesses that are generally chronic, complex and potentially life threatening. Often these therapies require specialized delivery and administration.
Is a mail order pharmacy a nonresident pharmacy?from npino.com
Mail order pharmacies are licensed as a Mail Order Pharmacy in the state where they are located and may also be licensed or registered as nonresident pharmacies in other states. Non-Pharmacy Dispensing Site.
Where do patient assistance programs come from?
PAPs are most often sponsored by pharmaceutical companies. There are also state programs and nonprofit-sponsored programs.
How to sign up for a med program?
To sign up, you will either call the program or sign up online. You will need to submit forms like your taxes and residence status to prove your eligibility. Most programs also require your health provider to fill out a form. Once you apply and enroll, there may be limits on how much medication you can get or how long the program lasts.
Can a patient assistance card help you?
Like manufacturer copay cards, patient assistance programs have received some criticism. But, they can and do help you if you are struggling to afford your medications. Keep reading to find out more about PAPs.
Does GlaxoSmithKline offer assistance?
For example, GlaxoSmithKline offers an assistance program for its medications Benlysta and Nucala. Here, under their qualification section, they show what your maximum monthly gross income must be under, depending on your household size and where you live.
What is patient assistance?
Patient assistance programs are a vital piece of the puzzle in helping patients navigate access to and afford their therapies. Data and analytics help inform when patient assistance may be needed for different programs or signal when it might be appropriate to reallocate resources elsewhere.#N#What you can discover: How do you support affordability for as many patients as possible?#N#The data you'll need: Your program data can show you what time (s) of year your patient assistance program (PAP) sees the biggest influx of patients or significant decline in adherence. Understanding and analyzing this flow can help manufacturers understand if the PAP is too inclusive or restrictive. Combining these fundamental data points with industry expertise from a qualified partner provides insight into when, for example, foundation support may have run out for the year and your PAP budget could be spread thin.#N#The analytics in action: Your patient services provider should be able to offer both insights into shifting PAP trends and compliant program design expertise in the preparations for helping patients navigate affordability barriers.
Is data good for patient support?
Data is only as good as the action it inspires . That is especially the case with patient support programs, which rely on analytics to help manufacturers navigate access and adherence barriers.#N#With the right partner and analytics program—including key metrics discussed in Part 1 of this series —manufacturers can pivot their services to respond to real-time trends and needs, making the program a powerful force for improving outcomes.#N#But what can your program data really do? Access to the right analytics and support from your patient services partner can drive three important data-driven decisions for your program:
Where do patient assistance programs come from?from goodrx.com
PAPs are most often sponsored by pharmaceutical companies. There are also state programs and nonprofit-sponsored programs.
Who sponsors drug assistance programs?from assistrx.com
Drug assistance programs are usually sponsored by life sciences organizations (manufacturer- sponsored), non-profit or charitable foundation-sponsored, or a combination of the two. Usually, they also fall into these categories:
What insurance do you need to get medical assistance?from aafa.org
Patient must be insured by Medicare, Medicaid or military benefits, and insurance must cover the medicine for which patient seeks assistance
What is a senior program?from aafa.org
Programs are for seniors and/or people with certain chronic conditions; The programs assist low-income seniors and adults with disabilities in paying for their prescription drugs
What is the purpose of the asthma coupons?from aafa.org
They compile coupons and prescription assistance information to help patients and families find free or reduced-cost asthma medicines.
How to sign up for a med program?from goodrx.com
To sign up, you will either call the program or sign up online. You will need to submit forms like your taxes and residence status to prove your eligibility. Most programs also require your health provider to fill out a form. Once you apply and enroll, there may be limits on how much medication you can get or how long the program lasts.
Can a patient assistance card help you?from goodrx.com
Like manufacturer copay cards, patient assistance programs have received some criticism. But, they can and do help you if you are struggling to afford your medications. Keep reading to find out more about PAPs.
What Stakeholders Are Most Impacted?
Multiple stakeholders stand to be impacted by the new rule, experts tell AIS Health.
CMS Disputes Patient Impact Comments
In response to several comments about the rule’s potential negative impact on adherence and outcomes for people with life-threatening or complex conditions who depend on financial assistance to be able to access specialty drugs, CMS replied, “We do not believe that the final policies we are adopting in this final rule will negatively impact patients with rare, life-threatening illnesses who rely on manufacturer assistance programs.
Does Pharma Know When Programs Are Used?
However, contends Mourad, manufacturers establishing coverage criteria around assistance programs “would be virtually impossible in the current environment, as manufacturers and consumers do not have insights into when or how the accumulator is even applied to a medication claim; they would have to obtain this data from the insurer.
What information should a PAP provider share with patients?
The company should also limit the information it shares about independent PAPs with patients and providers. For example, if the company’s reimbursement hub triages requests for co-pay or other financial assistance, the hub should provide only a general overview of the third-party assistance options to the patient or provider, along with contact information for each independent PAP that has an applicable fund and is currently accepting new applications (i.e., a “cold transfer”). Hub representatives should explicitly inform the patient or the patient’s provider that the referral to the independent PAP is not a guarantee of assistance and that the PAP has full discretion whether to provide assistance based on its own independent eligibility criteria. To this end, company personnel should generally be restricted from (a) filling out applications for patients or seeking information about the status of any individual application for assistance from any PAP, or (b) seeking detailed information regarding why and from which PAP any patients received or were denied assistance. In addition, the company should limit, as much as possible, the information coming from patients who were transferred to PAPs for assistance and who were denied or received assistance; if company personnel receive such information, they should not (1) share it beyond reimbursement support personnel, or (2) record it in the patient’s case notes.
What is the DOJ's interest in PAPs?
DOJ interest in drug company relationships with independent PAPs began in earnest in the midst of larger concerns regarding sharply rising drug prices. While investigating pricing schemes and specialty pharmacy relationships in 2015, DOJ began issuing subpoenas to pharmaceutical companies that manufacture expensive and specialty drugs that requested information on the companies’ relationships with independent PAPs. 9 Since then, the DOJ has broadened its inquiry to numerous pharmaceutical companies and independent PAPs.
What is a meaningful review and processing of funding requests?
Meaningful Review and Processing of Funding Requests: All requests should follow the company’s customary and generally applicable grant request processes, and these requirements should be incorporated within the PAP policy/procedure described above. The PAP policy/procedure should specify standardized, objective criteria for assessing requests from independent PAPs for both initial and additional or supplemental funding (e.g., funding beyond that which is set forth in the annual budget). Supplemental requests for funding must be reviewed for compliance with applicable Federal health care program requirements, OIG guidance, and company policies and procedures.
What are the restrictions on PAP data sharing?
Implementation of Data Sharing Restrictions: The company should take all necessary steps to ensure it does not receive (directly or indirectly through third parties) any data or information from the PAP that would enable the company to correlate the amount or frequency of its donations with support for its products or any related services. Such prohibited information may include individual patient information, or any information related to the identity, amount or nature of the products or services that are made available by the PAP from donations provided by the company, including any projections for additional funding required to continue a specific type of support. Within the company, the aggregate-level data received from independent PAPs should not be shared with commercial personnel.
When did the DOJ issue subpoenas to Valeant Pharmaceuticals?
9 DOJ issued subpoenas to Valeant Pharmaceuticals in October 2015, and Horizon Pharmaceuticals in early 2016, requesting information on the drug makers’ relationships with independent PAPs, while investigating both companies for their relationships with specialty pharmacies.
Does a Hub representative have to inform the patient or the patient's provider that the referral to the independent PAP?
Hub representatives should explicitly inform the patient or the patient’s provider that the referral to the independent PAP is not a guarantee of assistance and that the PAP has full discretion whether to provide assistance based on its own independent eligibility criteria.
Is it permissible for a charitable organization partly funded by kidney dialysis providers to pay Medicare Part B?
4 See OIG Adv. Op. 97-01 (June 11, 1997) (advising that it is permissible for a charitable organization partly funded by kidney dialysis providers to pay Medicare Part B, Medigap and other health insurance premiums for end-stage renal disease patients who are financially needy).
What is drug assistance?
Drug assistance programs—another term for patient assistance programs—can also be offered by state programs or independent third-party nonprofits/charitable organizations. Whether a patient qualifies for these programs will depend on their insurance and the prescribed therapy. Patients typically qualify for these programs if they do not have ...
Who sponsors drug assistance programs?
Drug assistance programs are usually sponsored by life sciences organizations (manufacturer- sponsored), non-profit or charitable foundation-sponsored, or a combination of the two. Usually, they also fall into these categories:
Why are patients more likely to abandon their prescriptions at the pharmacy counter?
As out-of-pocket costs increase, patients are more likely to abandon their prescriptions at the pharmacy counter. To avoid this outcome and improve patient adherence, pharmaceutical manufacturers are more likely to sponsor patient assistance programs.
Can patients receive medication for little or no cost?
Patients who qualify for patient assistance programs can receive medication for little or no cost, helping the most in-need patients gain access to therapy if they cannot afford the typical drug pricing.
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Where to Invest to Increase Awareness and Adoption
How to Allocate Program Resources
- There is no one-size-fits-all approach to patient support. And program management is all about optimization. Program data can help manufacturers align the right resources to patients who need the most support. What you can discover: Where can you introduce technology that blends with skilled and compassionate counselor support to effectively speed access to therapy and provid…
When to Expand Patient Assistance
- Patient assistance programs are a vital piece of the puzzle in helping patients navigate access to and afford their therapies. Data and analytics help inform when patient assistance may be needed for different programs or signal when it might be appropriate to reallocate resources elsewhere. What you can discover: How do you support affordability f...
The Crucial Role of Expertise
- In these three areas and beyond, the right patient support program partner will help manufacturers build a lasting strategy for removing barriers and accelerating speed to therapy. But delivering data is only part of the process; combining analytics with recommendations from a team of clinical and data science experts is essential.