Nearly 28.5 million Americans are currently uninsured or underinsured, leaving them at risk for drug costs they may not be able to afford.1 Even among patients with insurance, high-deductible health plans and increasing drug costs have resulted in significant affordability issues with many specialty medications and treatment plans. 

More than 25% of US patients have not filled a prescription or have reduced their prescribed dose because of high costs.2 Regardless of the setting—retail pharmacy, in-patient administration, or a specialty pharmacy—when patients can’t afford their medications, they are at risk of being non-adherent, which can result in emergency department visits, increase in overall health care costs, and/or worsening of conditions. 

In this article, we will review how patient assistance programs (PAPs) not only help relieve financial pressures across practice settings by offering free medications but can enhance the patient experience and support better outcomes.

Helping Patients Gets the Medications They Need
Affordability programs are designed to relieve financial pressures by helping those in need obtain their medications. There are currently some 372 PAPs covering more than 4100 drugs.3 Affordability generally comes in 2 forms:
 
  • Co-pay programs: Help reduce the patient’s out-of-pocket responsibility, including co-insurance and deductible support.
  • PAPs: The patient receives the prescription medication for free either from the hospital pharmacy or directly from the manufacturer.

McKesson RxO’s PAP Recovery team helps hospital and health system pharmacies successfully manage the ever-evolving PAP complexities by providing recovery services, including identifying eligible patients, completing and verifying enrollment and facilitating product recovery. The McKesson RxO® team alleviates challenges by using technology designed to store patient data, auto-populate required forms, and streamline and track the status of PAP applications.

With the recently launched First Dose technology, patients are automatically screened for potential PAP assistance prior to receiving treatment, giving case managers and clinicians more time to concentrate on patients and their quality of care.

Over the past year, the team has worked with 350 hospitals and health systems to support more than 18,450 patients, coordinating more than 28,400 free drug shipments and saving patients more than $225 million. Whether this covers $500,000 for a newly approved immunotherapy for an uninsured patient or $1200 every 3 weeks in co-pay support to cover chemotherapy treatments, PAPs represent a lifeline for patients who, without assistance, could not otherwise afford the medications they need.

RxCrossroads by McKesson implements patient assistance programs to provide drugs to eligible patients being treated at hospitals (CAH, ACH, academic centers) or in their community care settings. With more than 17 years of experience, RxCrossroads currently administers more than 50 active PAPs. Integrated programs are designed to address both access and affordability as financial limitations should never keep patients from the therapies that they desperately need.

If a patient has no commercial insurance—or the insurance is not enough to cover drug treatments—PAPs and partnerships with funding foundations enable qualified patients to receive rapid access to therapies. RxCrossroads processed approximately 300,000 PAP applications last year (with many completed within 2 business days) and dispensed more than 1.6 million prescriptions for patients in these programs.

Regardless of the customer or style of program—the goal is the same—help patients start and maintain their prescription treatment regimens.

Patients Need More Personalized Support
Although cost will almost always play some role in medication decisions, patients frequently face multiple barriers that can impact adherence and outcomes. Comprehensive programs must also address behavioral barriers, such as medication concerns, low self-efficacy, or perceived importance. Live agent support can be used to identify adherence barriers and be paired with financial assistance and educational support programs.

Historically, PAPs have been very narrowly focused on providing free products. Budgets for access and adherence programs commonly used to support patients with commercial insurance have typically been limited. There is currently a significant push for continuity of care and delivering robust support services to all patients.

With the ability to access more health care information and decision-making tools than ever before, patients want these tools to be personalized to their needs. More personalized communication, such as missed prescription reminders, refill reminders, live phone support, and pharmacist coaching are activities not regularly implemented with PAPs but are standard in co-pay programs and other manufacturer-sponsored patient support.

PAPs provide a critical lifeline for patients to get the medicine they might not be able to afford otherwise. With greater emphasis on the patient journey, biopharma companies and PAP service providers are placing a greater emphasis on delivering a consistent patient experience, whether or not they are enrolled in a PAP.

This includes designing programs that leverage technology and hub-like services to create greater connectivity to the pharmacy from the first discussion with their physician to the point of receiving the prescription, followed by ongoing education and adherence support.

This starts with affordability and access, but the key is personalized support throughout the patient’s treatment journey.

About the Authors
O’Mally Monahan
is senior director of Patient Assistance Services for McKesson.
Rob Brown is vice president and general manager of RxCrossroads by McKesson and Biologics by McKesson.

References
  1. Berchick E, Hood E, Barnett J. “Health Insurance Coverage in the United States: 2017.” Washington, DC: United States Census Bureau; 2018, Accessed September 11, 2019, census.gov/content/dam/Census/library/publications/2018/demo/p60-264.pdf.
  2. Ghazala Khan, MD1, Patrick Karabon , MS2, Sarah Lerchenfeldt , PharmD2, (March 2018) “Use of Prescription Assistance Programs After the Affordable Health Care Act,” J Manag Care Spec Pharm, 2018 Mar;24(3):247-251, https://doi.org/10.18553/jmcp.2018.24.3.247
  3. Choudhry, N. K., Lee, J. L., Agnew-Blais, J., and Corcoran, C. (May/June 2009). “Drug Company–Sponsored Patient Assistance Programs: A Viable Safety Net?” Retrieved June 28, 2017, http://content.healthaffairs.org/content/28/3/827.long