What is a Patient Assistance Program?

By: Amanda O’Hora, Tracy Baroni Allmon, Jennifer Ellis

Patient assistance programs typically offer free or discounted medications, copay assistance, or other forms of assistance to patients who are uninsured or underinsured and cannot afford their medications.

Many drug manufacturers offer patient assistance programs (PAPs) to help patients access the medications they need but cannot afford.

Who Qualifies for PAPs Support?

Each patient assistance program may have its own specific eligibility requirements, application process, and types of assistance, but will typically require the following criteria to qualify:

Insurance: Many PAPs may require patients to be uninsured or underinsured (ie, have insurance but do not have coverage for the required medication)

Income: Many PAPs will require patients to have an income below a certain percentage of the Federal Poverty Level (FPL), typically between 200% to 500% per household

Residency: Patients must typically be residents of the country (eg, the US) in which the program is offered

How PAPs Improve Patient Access

Patient assistance programs play a crucial role in improving access to medications and healthcare for patients in need through several key mechanisms, including:

  • Financial Assistance: Payment assistance programs often provide free or reduced-cost medications to eligible patients, helping those who cannot afford their prescriptions due to high copays, deductibles, or lack of insurance
  • Education and Support: Many payment assistance programs offer educational resources to help patients understand their conditions and treatment options. This support can empower patients to make informed decisions about their healthcare
  • Streamlined Application Processes: Payment assistance programs typically have dedicated staff who assist patients in navigating the application process, ensuring that eligible individuals can easily access the support they need
  • Coordination of Care: Some programs collaborate with healthcare professionals (HCPs) to ensure that patients receive comprehensive care, including regular check-ins and follow-ups, which can improve adherence to treatment plans
  • Increased Awareness: PAPs often work to raise awareness about available assistance, reaching out to underserved populations who may not be aware of their options for obtaining medications
  • Access to Specialty Medications: Many payment assistance programs focus on providing access to specialty medications, which are often high-cost treatments for chronic or complex conditions, thus ensuring that these essential therapies are available to those who need them most
  • Referral to Other Resources: Payment assistance programs can connect patients with additional resources, such as transportation assistance, nutritional support, or housing services, which can further enhance their overall health and well-being
  • Flexibility in Eligibility: Payment assistance programs often have more flexible eligibility criteria compared to traditional insurance, allowing a broader range of patients to qualify for assistance based on factors such as income, medical necessity, and treatment needs

By addressing financial barriers, providing education, and facilitating access to essential medications, PAPs play a vital role in improving healthcare outcomes for patients who may otherwise struggle to obtain necessary treatments.

Connecting Patients With PAPs

If patients are interested in learning more about available PAP programs, they can ask their HCP or pharmacist. Patients can also learn about patient assistance programs through a manufacturer’s website or a general patient support website, such as goodrx.com, rxassist.org, or needymeds.org. Non-profit organizations and foundations, such as the National Organization for Rare Disorders (NORD) and the Patient Advocate Foundation (PAF), may also provide patient support for specific conditions.

One way Magnolia is helping manufacturers with their patient support programs is by developing customized patient support financial models to estimate patient utilization and costs of their programs. The financial model is important for manufacturers to plan their budgets for upcoming years and ensure that they are prepared and have enough funds to cover patients’ needs and promote continued treatment. The financial model can also help manufacturers see the impact of changing program parameters, such as patient eligibility based on Federal Poverty Level (FPL), as well as the impacts of changes to insurance plan design.