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Patient Assistance Programs for Prescription Medications

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Most U.S. pharmaceutical companies that manufacture and market medications in the United States have programs in which they give free medications to select indigent people who lack prescription drug insurance. These programs are commonly called Patient Assistance Programs (PAPs). Recently, these PAPs have become better known to the public, though in the current health care reform debate they have received surprisingly little attention.

The potential use of PAPs is huge, since up to 40 million Americans lack health insurance. According to the Pharmaceutical Research and Manufacturers of America, an industry group, nationwide drug companies gave away $8 billion in medications by filling 35 million prescriptions in 2009.

Some of the older drug companies have offered free drugs for over 50 years. Historically, much of that was done informally by delivering free medications at doctors’ offices. However, as the number of the manufacturers proliferated, the drug companies began to set up formal programs in which individual patients would apply for free drugs directly to the drug companies. There are presently more than 250 free drug programs in the United States. Although there are similarities in the different programs, the specific requirements and paperwork vary from program to program.

A business I started back in 2003 arose from the fact that PAPs are complex in nature and scope; and they are not user friendly, especially when one considers that the target audience of these programs – often elderly, indigent patients with high cost medication needs and no insurance as well as often low education and awareness – is usually poorly equipped to deal with PAPs’ complex rules and eligibility requirements. Also the amount of documentation that some programs demand are daunting even for savvy patients. Plus over the years many programs have been changed, canceled or suspended without notice and most programs require differing documentation. So, for example, one maker of cardiovascular women’s health medication recently unilaterally suspended its free drug program for new patients because it stated that it was oversubscribed. Applicants for free medication may have difficulty submitting their paperwork to the drug companies, because there are many different PAPs, and many eligible drugs. Many of the forms for free medication are only available on the Internet. Many of the indigent Americans who qualify for free medications through a PAP lack Internet access. In 2003, even fewer indigent Americans who qualified for free medication had access to the Internet, where some (but not all) forms were available. We sought to fulfill the needs of up to 40 million Americans by assisting them in obtaining free medication for which they were qualified but either did not know that they were eligible; or alternatively they lacked the knowledge or ability to apply for free medications themselves.

Some doctors help indigent patients obtain free medication through a PAP; however most doctors lack the time and resources to maintain up to date forms and information required of a successful application.  Applying for free medication is also difficult because some companies reject applications without notice to the patient; that an application has been made and no response is received may mean a number of things, including that the drug company has not reviewed the application, that it was rejected and set aside, or some other problem.  The current applications for free medication may only cover a short time and have to be resubmitted periodically in order for the patient to continue receiving their medication.  These free drug programs tend to be understaffed by the drug companies.  The programs are not necessarily designed to make the process either easy to understand or easy to complete.

After a new patient subscribed to our service, he or she got sent a packet of material including paperwork to be completed that requires the applicant to specify the particular medications that the patient needs.  After the patient specified the particular medications needed and returned the registration package, we used specially designed software and experienced staff to prepare more detailed paperwork that specifically addressed the medications that the patient requests.

Our proprietary software was developed by a specialized software company that works with hospitals and other non-profit and faith-based organizations working in this field.   Much like a computer anti-virus software downloads regular updates so that it may respond to the changing threats of hackers, our proprietary software downloads daily updates from the drug companies, so that on any given day, we are using the most recent forms and procedures required to access the free medication programs.  Failure to use the most recent forms and procedures required by drug companies may result in denial of a patient's application. We can then send individually tailored paperwork to the patient for signature. 

During this stage, the patient's doctor must also sign the forms, and provide a prescription for the medication.  Once the patient gathers this information and returns the paperwork to us, then we would file it with the relevant U.S. drug company, so that the medication may be shipped directly to the patient or his or her doctor.  Some drug companies require supporting documentation with the application for free medicine, such as proof of income and insurance status.  At this stage, our company may request additional information from the patient in order to satisfy the drug company's specific requirements.Using our software our staff processed the individual drug companies' applications, and sends them to the specific drug companies on behalf of the patient.  

For the stated reasons above, U.S. pharmaceutical company Patient Assistance Programs (PAPs) should be an integral part of the new, reformed health care system currently being debated in Congress.  U.S. pharmaceutical companies have offered these programs for years, so there should be no debate as to their assistance to low income uninsured Americans.  By integrating and expanding PAPs in the current health care environment the overall cost to taxpayers will be reduced. 

PAPs are highly relevant in the current health care debate.  By expanding their use and coverage, they will enable other reforms to be made.  U.S. pharmaceutical companies absorb the costs of these programs, so there is no taxpayer money involved.

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About Geoff Hasler

  • http://etierphotography.blogspot.com/ FCEtier

    Geoff,
    Is your company still in business? I couldn’t discern from your article how you make money if your clients are indigent. It’s hard to imagine the drug companies paying someone to help them give away their meds. I’ve referred patients to the manufacturers countless times over the thirty years of my practice and it’s surprising that you and I haven’t crossed trails…