Pharmaceutical manufacturers may sponsor patient assistance programs (PAPs) that provide financial assistance or drug free product (through in-kind product donations) to low income individuals to augment any existing prescription drug coverage. PAPs can provide assistance to Part D enrollees and interface with Part D plans by operating "outside the Part D benefit" to ensure separateness of Part D benefits and PAP assistance.
How can a PAP provide assistance to Part D enrollees?
PAPs can provide assistance to Part D enrollees and interface with Part D plans by operating "outside the Part D benefit" to ensure separateness of Part D benefits and PAP assistance. The PAP's assistance on behalf of the PAP enrollee does not count towards a Part D beneficiary's true-out-of-pocket cost (TrOOP).
What are patient assistance programs (Paps)?
Commonly referred to as PAPs, Patient Assistance Programs are services offered by pharmaceutical companies for those who cannot afford their medication. Patient assistance programs are available to low-income individuals or families who are under-insured or uninsured and are provided to those who meet the eligibility guidelines.
What are the costs associated with patient assistance programs?
In most cases, there is no cost associated with patient assistance programs. If there are any costs for the program, it will be displayed in the profile for the pharmaceutical company whose medication you are inquiring about. Many PAP's provide their medication completely free or at a significant discount off the uninsured cost.
What information will the Patient Assistance Program request from my physician?
Each patient assistance program enrollment will detail what information they will need from your physician. As stated before, there are no unified guidelines for what each company requests, however you can expect that many will require similar information. Below you will find a list of the information most commonly requested from your physician.
What are two options for Medicare consumers getting Part D?
Those who qualify for Medicare Part D must have Medicare Part A and/or Part B. You may have the choice of two types of Medicare plans—a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan.
Why do pharmaceutical companies offer patient assistance programs?
They increase demand, allow companies to charge higher prices, and provide public-relations benefits. Assistance programs are an especially attractive proposition for firms that sell particularly costly drugs. Faced with high out-of-pocket costs, some patients may decide against taking an expensive medication.
What is USA medical prescription assistance program?
The Emergency Prescription Assistance Program, or EPAP, helps people in a federally-identified disaster area who do not have health insurance get the prescription drugs, vaccinations, medical supplies, and equipment that they need.
What is Alabama prescription assistance program?
SenioRx can help with the high cost of prescription drugs. This prescription assistance program strives to reduce economic stress, promote better health and improve the quality of life by providing ways to reduce the expense of life sustaining medications.
What happens if you can't afford a prescription?
Many pharmaceutical companies, state programs and nonprofits have drug assistance programs (PAPs) that offer free or low-cost medicines if you don't have insurance or are underinsured and can't afford your medicine. Programs and program benefits vary.
Is prescription Assistance 123 legitimate?
The answer is yes. We are a legitimate service that is offered to those who really need our help. Our employees always strive for excellence and treat confidentiality and HIPPA regulations with the highest importance, as it is our duty to uphold them on behalf of our clients.
What is a patient support program?
A patient assistance or support programs (PAPs or PSPs) exist to get you timely access to medication and to help you stay on track of your therapy. Being diagnosed with a complex disease or condition may come with unexpected financial burden and a need to better understand treatment options and next steps.
What sources of assistance are available for medical and prescription needs?
There are several ways you can get help paying for your prescription medicine.Private and public health insurance. Many people have health insurance. ... State and community programs. Some state governments offer affordable medicine programs. ... Private programs. ... Patient-assistance programs. ... For more information.
What is Pfizer Assistance Program?
Pfizer RxPathways® patients in need get access to their Pfizer medicines. Today, Pfizer RxPathways® connects eligible U.S. patients to a range of Pfizer assistance programs that provide insurance support, co-pay help, and medicines for free or at a savings.
What is patient services in pharma?
Driven by market dynamics and consumer demand, patient services is a growing business segment for life sciences companies that simultaneously addresses fragmentation in patient care delivery, improves adherence to therapies, and increases patient consumer satisfaction.
What is a patient support program?
A patient assistance or support programs (PAPs or PSPs) exist to get you timely access to medication and to help you stay on track of your therapy. Being diagnosed with a complex disease or condition may come with unexpected financial burden and a need to better understand treatment options and next steps.
How does the pan foundation work?
What does PAN cover? Our 12-month grants offer financial assistance for out-of-pocket medication costs, including co-pays, health insurance premiums, and transportation costs associated with medical care. Co-pay funds: assistance with deductibles, co-pays, and coinsurance for medications.
Does Novartis have a patient assistance program?
Novartis Patient Assistance Foundation provides medicines at no cost to eligible US patients who are experiencing financial hardship.
What are Patient Assistance Programs?
Commonly referred to as PAPs, Patient Assistance Programs are services offered by pharmaceutical companies for those who cannot afford their medication. Patient assistance programs are available to low-income individuals or families who are under-insured or uninsured and are provided to those who meet the eligibility guidelines. Assistance may range from reduced cost of drugs to free medicine. Each drug that a company offers will have its own unique program and may even have a different eligibility requirement than the other drugs they offer. As there is no unified standard of designation for these programs, you may also see them referred to as medication assistance programs, indigent drug programs, and charitable drug programs.
Are there general eligibility requirements?
After properly identifying the pharmaceutical company who offers the medicine you would like assistance with, you can begin the the enrollment process. The initial enrollment form along with detailed company information and eligibility requirements are listed in each profile in our database.
What steps do you need to take?
Yes. Although eligibility differs from program to program, they all have three specific criteria in common.
What other material will I need to provide besides the enrollment form?
Many pharmaceutical companies will require additional material to be submitted along with your completed enrollment form. As stated before, there are no unified guidelines for what each company requests, but you can expect that many of them will require similar information. Below you will find a list of the information most commonly requested by patient assistance programs.
What is required of my physician during the enrollment process?
While they're are some enrollment processes that do not require interaction from your physician; many request that they provide answers to question on the form or directly sign it. Each patient assistance program enrollment will detail what information they will need from your physician. As stated before, there are no unified guidelines for what each company requests, however you can expect that many will require similar information. Below you will find a list of the information most commonly requested from your physician.
When should I expect to receive my medication?
After your enrollment application has been accepted to the patient assistance program, it may take up to 6 weeks before you start receiving your medication . If the enrollment form stated that your medicine will be sent to the nearest pharmacy or your doctors office, it is recommenced that you provide them with your most recent contact information so they can inform you that your medication has arrived.
How are refills handled?
To request a refill, you or your physician will have to contact the pharmaceutical company. Who contacts the company is dependent on the requirements of the PAP that you have enrolled in. Please keep in mind that you may only request a refill during your enrollment period. Each program will clearly state how often you need to resubmit your application. Failure to do so will result in a termination of the provided services and a rejection of your refill request. As each program is different, please refer to your patient assistance program's profile in our database for information regarding the refill process and enrollment duration.
How to reduce fraud and abuse exposure?
In addition to taking steps to transition beneficiaries to other programs, pharmaceutical manufacturer PAPs can reduce their fraud and abuse exposure by taking one or more of the following steps: (i) Adjusting financial need criteria to reflect the lower drug costs incurred by Part D enrollees ( i .e., liability for premiums and cost-sharing amounts only, instead of the total cost of the drugs); (ii) where possible , subsidizing other drugs in the same class as the manufacturer's products covered by the PAP if a beneficiary's physician prescribes an alternate product; and (iii) checking CMS eligibility files, to the extent available , on a reasonably regular basis to determine whether PAP patients have enrolled in Part D and should be transitioned to other assistance programs. Occasional, inadvertent cost-sharing subsidies provided to a Part D enrollee should not be problematic ( e.g., where, despite due diligence, a pharmaceutical manufacturer PAP does not know and should not have known that a beneficiary has enrolled in Medicare Part D). Notwithstanding a pharmaceutical manufacturer's compliance with the foregoing, the Government will take enforcement action in cases where there is evidence of unlawful intent.
What is OIG guidance?
OIG periodically develops and issues guidance, including Special Advisory Bulletins, to alert and inform the health care industry about potential problems or areas of special interest. This Federal Register notice sets forth the recently issued OIG Special Advisory Bulletin addressing patient assistance programs for Medicare Part D enrollees.
What is cost sharing in PAP?
Cost-sharing subsidies offered by a pharmaceutical manufacturer PAP to the dispensing supplier differ in two important respects from a provider's or supplier's unadvertised, non-routine waiver of cost-sharing amounts based on a patient's financial need, which has long been permitted. First, the subsidies result in the dispensing supplier receiving full payment for the product and avoiding the risk of non-collection, thus providing the supplier with an economic incentive to favor the subsidized product and a disincentive to recommend a lower-cost alternative, such as a generic. In addition, the availability of PAP assistance is typically advertised and may influence a beneficiary's choice of product (through the prescribing physician acting on behalf of the beneficiary). Moreover, once a beneficiary is enrolled in a pharmaceutical manufacturer PAP, the beneficiary is effectively locked into using the pharmaceutical manufacturer's product, since the beneficiary risks losing financial assistance if he or she switches products, even if an equally effective, but less expensive, product would be in his or her best medical interests.
What is the anti-kickback statute?
The Federal anti-kickback statute, section 1128B (b) of the Social Security Act (the Act), [ 5] makes it a criminal offense knowingly and willfully to offer, pay, solicit, or receive any remuneration to induce or reward the referral or generation of business reimbursable by any Federal health care program, including Medicare and Medicaid. Where remuneration is paid purposefully to induce or reward referrals of items or services payable by a Federal health care program, the anti-kickback statute is violated. By its terms, the statute ascribes criminal liability to parties on both sides of an impermissible “kickback” transaction. For purposes of the anti-kickback statute, “remuneration” includes the transfer of anything of value, directly or indirectly, overtly or covertly, in cash or in kind. The statute has been interpreted to cover any arrangement where one purpose of the remuneration was to obtain money for the referral of services or to induce further referrals. Violation of the statute constitutes a felony punishable by a maximum fine of $25,000, imprisonment up to five years, or both. OIG may also initiate administrative proceedings to exclude a person from Federal health care programs or to impose civil money penalties for kickback violations under sections 1128 (b) (7) and 1128A (a) (7) of the Act. [ 6]
What are the issues with PAPs?
Analytically, pharmaceutical manufacturer PAPs raise two main issues in connection with the Part D program: (i) Whether subsidies they provide can count toward a Part D enrollee's true out-of-pocket costs (known as the TrOOP); and (ii) whether the subsidies implicate the Federal anti-kickback statute. [ 7]
Why is it important for PAPs to provide free drugs outside of Part D?
In addition, to promote quality of care, we believe it would be important for PAPs that provide free drugs outside the Part D benefit to coordinate effectively with Part D plans so that the plans can undertake appropriate drug utilization review and medication therapy management program activities .
What is the determination regarding whether a particular arrangement violates the anti-kickback statute?
A determination regarding whether a particular arrangement violates the anti-kickback statute requires a case-by-case evaluation of all of the relevant facts and circumstances , including the intent of the parties. For PAPs, the nature, structure, sponsorship, and funding of the particular PAP are necessarily relevant to the analysis.