Patient Assistance Programs: Lower the Cost of Medications
Overview of Patient Assistance Programs
Patient Assistance Programs (PAPs) are programs created by pharmaceutical and medical supply manufacturers to help financially needy patients purchase their necessary medications and supplies.
Discussion and the Pros and Cons of Patient Assistance Programs
The eligibility requirements and benefits of patient assistance programs are determined by each individual pharmaceutical company or medical supply manufacturer. There are programs designed for patients that do not have insurance and other programs for individuals whose insurance co-payment amounts are prohibitively expensive for their income levels. Still other programs are designed to assist those with specific types of insurance such as Medicare Part D.
The duration of one’s enrollment in a patient assistance program also varies. Some programs require participants to reapply with each new prescription, others require annual re-application. Most programs will provide a 90 day supply.
Why do pharmaceutical companies have PAPs? There is not a black and white answer to this question. Pharmaceutical company representatives will respond by discussing their organizations’ commitments to social health. Social medicine advocates may argue that these companies are doing the minimum possible and that they make participation in their programs difficult by adding layers of bureaucratic red tape. The true answer may lie somewhere in the middle. It makes good business sense to have a PAP. Patients who otherwise could not afford the medicine receive it, the pharmaceutical company receives partial payment from the insurance providers and they get the positive PR from the program.
Patient Assistance Programs are Also Known As:
- Financial Assistance Programs
- Prescription Assistance Programs
- Patient Assistance Foundations
Qualifications for Patient Assistance Programs
The eligibility requirements differ for each organization’s assistance program.
Age requirements differ for each program however for the vast majority of programs, the patient’s age is not a factor when considering their eligibility.
Disabilities / Health Requirements
Participants in patient assistance programs are required to provide proof of the need for a prescription or medical supply. Typically a written prescription for a medication is adequate but in some cases separate documentation from the applicant’s doctor is required.
Marital or family status is not a disqualifying factor in most patient assistance programs. However, the number of members in the applicant’s household will usually impact the income limits for participation in the program.
Financial Status Requirements
Every program has different financial requirements. Typically eligibility is based on one’s income. Many programs use the federal poverty guidelines or some percentage thereof as income thresholds. For example, if one’s income is less than 300% of the federal poverty guideline (in 2012 this is $33,510), then they would qualify for assistance. In real dollar terms, most programs have income maximums of between $20,000 - $30,000 for individuals, and for couples between $30,000 - $40,000.
Some assistance programs have two-tiered eligibility requirements. For example, if your annual income is below $20,000 / year, the prescription or supplies might be completely free or if your income is under $30,000, you might receive a 75% price reduction.
It is important to note income itself may not be the sole factor rather a patient’s out-of-pocket cost for a medication has an impact as well. Some medications, even with insurance, require patient co-payments of 100s or even 1000s of dollars per month. In these instances, eligibility decisions may be made by the gap between a participant’s income and their costs instead of based solely on their income.
Veteran Status Requirements
Veteran status usually has no impact on eligibility for patient assistance programs
Other than being a US resident, a senior’s place of residence does not typically impact eligibility for patient assistance programs. It is unlikely shipments of a medication can be made to a US resident whose is abroad.
Some patient assistance programs require an individual to have insurance; others are only available to those without insurance. Therefore while insurance can be an eligibility factor, it is specific to the program. Note that some pharmaceutical companies may have different assistance programs entirely for persons who have and do not have insurance.
Benefits of Patient Assistance Programs
Types of Benefit Payout
Each patient assistance program has a different structure. Typically they provide assistance in one of the following ways.
- Reimbursement – your costs or a percentage of your costs are reimbursed after purchasing and providing receipt.
- Coupons – discount coupons that you redeem directly with your pharmacy or supplies company.
- Direct discounts at your pharmacy – the program has a direct relationship with the pharmacy and the discount is applied at the time of purchase.
- Free product – shipped directly to the program participant.
Benefits Amounts & Limits
The benefit limits depend both on the patient assistance program and the participating individual’s needs and resources. Some participants may receive as much as a 100% price reduction on their supplies and medications while other may only receive a 20% reduction.
Time to Receive Benefits
Each patient assistance program has its own timeline; processing and delivery of benefits can happen in as little as one week’s time or can take several months.
Costs of Patient Assistance Programs
Since these programs are designed for the financially needy, typically there is no cost to participate in the program. In the rare case where there is a fee, the net savings will more than cover the cost of the fee.
There are also 3rd party services that will manage the application and renewal process on their clients’ behalf. These services may charge their clients on per medication or per program basis or an annual flat fee. While it is not difficult for a normal adult to manage the application and renewal process, some elderly patients may find the process frustrating or confusing. For these individuals these services may be worth the small fees they charge.
How to Apply for Patient Assistance Programs
One applies for a patient assistance program directly with the pharmaceutical company or supply manufacturer. Typically they will request the applicant’s age, state of residence, income, prescriptions, insurance and medical providers information. Be aware that some programs require you to re-apply with each new prescription.
The easiest way to determine if there is a patient assistance program available is to make a list of medications and search this online database of patient assistance programs.
There are also 3rd party services that will manage the application and renewal process on their clients’ behalf. Typically these services charge their clients on per medication or per program basis each month.
List of Major Pharmaceutical Company Patient Assistance Programs:
Page Reviewed / Updated - Aug. 2012