What Are Patient Assistance Programs?
Key takeaways:
Patient assistance programs (PAPs) help people with no health insurance and those who are underinsured afford medications.
These programs are managed by pharmaceutical companies, nonprofits, and government agencies.
PAPs may cover the full cost of medications or provide a discount.
Many Americans are partially shielded from the high cost of prescription drugs through employer health insurance, Medicaid, or Medicare. However, coverage gaps and formulary restrictions can burden even those with insurance. And those without health insurance or adequate coverage must pay for their medications out of pocket.
Patient assistance programs (PAPs) are usually sponsored by pharmaceutical manufacturers and are promoted as a safety net for Americans who have no health insurance or are underinsured. The goal of these programs is to provide financial assistance to help these patients access medications for little or no cost.
Like manufacturer copay cards, PAPs have received some criticism. But they can and do help people who are struggling to afford medications. Keep reading to find out more about PAPs.
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Where do patient assistance programs come from?
PAPs are most often sponsored by pharmaceutical companies. There are also state programs and nonprofit-sponsored programs.
How do patient assistance programs work?
If you don’t have insurance, or are underinsured and can’t afford medication, these programs often offer free or low-cost options. The benefits you receive vary widely from program to program. And programs often have different requirements.
How do I know if I qualify?
Unfortunately, there is no standard enrollment process. Each program defines and sets their own qualification standards.
In general, you must meet the following requirements:
Be a permanent, legal resident of the U.S. or Puerto Rico
Prove you are uninsured or that your insurance doesn’t cover your medication
Meet certain income eligibility requirements
To sign up, you will either call the program or register online. You will need to submit forms like your tax documents and proof of residence to prove your eligibility. Most programs also require your healthcare provider to fill out a form. Once you are enrolled, there may be limits on how much medication you can get or how long the program lasts.
For example, the manufacturer GlaxoSmithKline offers an assistance program for its medications Benlysta and Nucala. In their qualification section, they list what your maximum monthly gross income must be under, which is dependent on your household size and where you live.
What are some examples of these programs?
Here is a list of some of the largest patient assistance programs:
Why are patient assistance programs criticized?
While these programs can provide serious benefits, they are difficult to access and understand. A 2009 study showed that only half of the programs would disclose their eligibility criteria freely. Many see the sign-up process as deliberately confusing and tedious.
Patients typically can’t apply to PAPs without involving their care team, because healthcare providers need to fill out part of the application. A 2018 study suggested providers don’t always know which patients would be best for which PAPs because of a lack of clear information on eligibility and benefits.
These programs can also force patients to choose a specific brand name medication, even if there are cheaper and more effective alternatives available.
How can I find patient assistance programs for my medication?
If you are taking a certain medication and are unsure if there is a PAP available, you can:
Search your medication on GoodRx, then scroll down and look under “Savings Tips.”
Google your medication’s name plus “assistance program” or “savings program.”
Call your medication’s manufacturer and ask if they have an assistance program.
Check the medicare.gov directory of patient assistance programs.
Check out the GoodRx Helps Medication Assistance Program, which provides free medications through community and charitable clinics across the U.S.
The bottom line
If you’re struggling with prescription drug costs, PAPs can help you afford medication whether you have health insurance or not. Pharmaceutical companies, nonprofit organizations, and government agencies, provide this type of financial assistance. Some programs offer complete coverage, while others give you a discount.
Why trust our experts?
References
Choudhry, N. K., et al. (2009). Drug company-sponsored patient assistance programs: A viable safety net? Health Affairs.
Gilead Advancing Access. (n.d.). Homepage.
GSK for You. (n.d.). GSK patient assistance program for prescription medicines.
GSK for You. (n.d.). Homepage.
Healthwell Foundation. (n.d.). Homepage.
Lilly Cares Foundation. (n.d.). Homepage.
Medicare.gov. (n.d.). Find a pharmaceutical assistance program for the drugs you take.
Novartis Pharmaceuticals. (n.d.). Patient assistance.
NovoCare. (n.d.). Patient assistance program.
PAN Foundation. (n.d.). Homepage.
Pfizer Rx Pathways. (n.d.). Homepage.
U.S. Department of Health and Human Services. (2014). Special advisory bulletin: Pharmaceutical manufacturer copayment coupons.
Yezefski, T., et al. (2018). Patient assistance programs: A valuable, yet imperfect, way to ease the financial toxicity of cancer care. Seminars in Hematology.
