Patient assistance programs seek to provide access to brand-name prescription drugs at little or no cost to uninsured and low-income patients. They have helped millions of patients access medication that they would otherwise be unable to.
The complex nature of health care financing and delivery have challenged the ability of these programs to offer help. Here are some reasons why the programs are becoming more challenging to manage.
Continuously rising drug prices
The cost of most medication has been increasing progressively for a long time. Specialty drugs designed to address chronic and complex medical problem have seen significant changes in price, with some treatment plans exceeding $12,000 per month.
Most patients, even though they may not fall within the financial threshold for these programs, will not be able to access medication at current costs. By focusing only on uninsured and low-income persons, PAPs could fail to provide help to people who may genuinely need it.
A value-based care system
As care facilities take on more financial responsibility due to value-based reimbursement agreements, effective management of PAPs becomes a critical aspect of assistance. The value-based care system necessitates that organizations offer patient assistance balance between their financial and community responsibilities, which might mean that fewer people can access their medication.
The number of uninsured people has been declining due to favorable changes brought about by the Patient Protection and Affordable Care Act. Even so, millions of people are still uninsured and have no financial support for their medication. Many programs are designed to help these people access medication.
Some insurance packages do not offer full coverage for patients. People under these packages would need to increase their out-of-pocket payments for medication, which can be overwhelming for a large number of people. Prescription assistance for the uninsured patients excludes the underinsured patients who may also be unable to afford their medication.
Challenges in consolidating patient assistance efforts
Hospitals and other care facilities have taken up efforts to merge and expand. While this may result in more care for the community, it also results in the disorientation of existing patient assistance networks. The care providers have to consider new requirements, demographics, and policies. Many mergers may cause challenges in the consolidation of assistance efforts, which may result in fewer people accessing help.
High deductible health plans.
Shifting from a Payer-Based system of Healthcare financing to a patient-based system has resulted in greater financial responsibility for patients.
High deductible Health Plans (HDHP) have increased patient financial contribution to the cost of medication, which has made more people unable to access their medication. To maximize their benefit, PAPs must take into account the increased number of people who are unable to access medication as a result of changes to the financing structure.
A complex health benefit system
Health plan benefits have incorporated new levels, which has made coverage too complex. Many plans feature up to four tiers, each with its own deductible and CoPay levels, as well as a range of approved drugs.