Why Is The Patient Assistance Program So Important?

Usually, people are partially covered from the high cost of prescription drugs via the employer health insurance, Medicaid, or Medicare options. However, there are coverage gaps and formulary restrictions that can be challenging for those who have insurance too. 

And those people who do have health insurance or adequate coverage have to pay from their own pocket for the medications. 

What actually is a patient assistance program?

Patient assistance programs (PAPs) are ideally sponsored by pharmaceutical manufacturers and are promoted as a safety net for those who do not have  health insurance or are not insured. The main goal of these programs is to provide financial assistance to help these patients access medications at affordable or no cost.

PAPs are specially designed to qualify patients and their families to locate free or reduced-cost prescription drugs. These assistance programs are offered by the drug manufacturers, discount drug programs and discount pharmacy programs.

  • The main objective of the patient assistance program is to assist people without health insurance and those who are underinsured afford medications.
  • These are specially designed programs that are managed by pharmaceutical companies, non-profits, and government agencies.
  • PAPs may vary from case to case. It might cover the full cost of medications or provide a good discount.

Though PAPs are not appreciated by many, they still focus on helping people who are struggling to afford medications. 

How does the patient assistance program work?

Patient assistance programs (PAPs) help in evaluating and identifying sources of free and pocket friendly medications offered by pharmaceutical companies. The process reduces paperwork and offers direct access to programs that saves time for both the parties.

The collaboration is made by the staff members with the medical personnel and community agencies such as churches, hospitals and social services to share details about the patients, spot on resources and determine how the particular community can best help individuals access assistance programs.

If you don’t have insurance, or you are under insured and fail to manage medical expenses, these programs often offer free or affordable options. The key benefits widely vary from program to program as the requirements are different for all programs.

What is the main source of patient assistance programs (PAPs)?

Most often the patient assistance programs are sponsored by pharmaceutical companies followed by the state programs and also nonprofit-sponsored programs.

How do one qualify for patient assistance programs?

Though there is no standard enrollment process, each program defines and sets their own qualification standards. However, one has to meet the below requirements.

  • He/She should be the permanent & legal resident of the U.S. or Puerto Rico.
  • There should be evidence to prove you are uninsured or that your insurance does not cover your medication.
  • You should also meet the income eligibility requirements.

One important criteria for eligibility for the program is based on the income guidelines set by sponsoring pharmaceutical companies. Many sponsoring companies extend benefits to the enrolling candidates of the program who have insurance – till the medicines for which assistance is requested are not protected by current policy benefits. 

The individuals with annual incomes 200 to 400% of the federal poverty level or senior citizens in Medicare qualify for the PAPs. Patients whose income or resources disqualify them for existing drug assistance programs via drug manufacturers will receive consultation from other sources at affordable prescriptions.

Inorder to get enrolled to this program, you can do it online or by connecting with www.simplefill.com. You will have to submit forms like your tax documents and resident proof to prove your eligibility. 

Most of the programs also demand the form to be filled up by the healthcare provider to fill out a form. Once you are enrolled successfully, there is a certain limit for medication you can acquire or the duration of the program.

Let’s take an example – The manufacturer A offers an assistance program for its medications X and Y. In their qualification section, they will showcase what should be your maximum monthly gross income, which is dependent on your household size and where you reside.

Some examples of patient assistance programs (PAPs)

There are many examples of patience assistance programs. Here are a few out of the largest patient assistance programs: PAN Foundation, Healthwell Foundation, Pfizer Patient Assistance Program, Novartis Patient Assistance Foundation, GSK Patient Assistance Program, Gilead Advancing Access Program, Novo Patient Assistance Program, Lilly Cares Foundation Patient Assistance Program.

Why are patient assistance programs criticised by many?

While these programs can provide serious benefits, they are difficult to access and understand. Studies show that only half of the programs would showcase their eligibility criteria. The sign up process seems to be confusing and tedious. Patients fail to apply to PAPs without involving their care team, because healthcare providers need to fill out part of the application. 

The providers do not always know which patients would be best for which PAPs as they miss out the information on eligibility and benefits. These programs also force patients to choose a specific brand name medication, even if there are relatively affordable and more effective options available. 

How to become a Simple Fill partner?

Connect with www.simplefill.com to learn more about the benefits and latest eligibility criteria. These are well known consultants that are available to meet with you and your agency upon request to discuss your requirements. These are experienced and knowledgeable consultants who collaborate with medical personnel, social service agencies, faith based organisations, government agencies, non-profit organisations, free clinics and other community groups to provide information about PAPs and the software used by the program. When the agency or organisation decides to participate, the consultants can provide adequate training.

Final Wrap

If you are struggling with prescription drug costs, patient assistance programs (PAPs) can help you afford medication whether you have health insurance or not. Many pharmaceutical companies, nonprofit organisations, and government agencies, provide such types of financial assistance. Some PAPs offer complete coverage, while others offer significant discounts.

Michael Caine

Michael Caine is the Owner of Amir Articles and also the founder of ANO Digital (Most Powerful Online Content Creator Company), from the USA, studied MBA in 2012, love to play games and write content in different categories.