Patient assistance portals make their debut

Help is on the way for patients who cannot afford prescription drug care. Pharmacy and pharmaceutical manufacturers have rolled out clearinghouse services to guide pharmacists, prescribers, and the public through the tangle of patient assistance programs (PAPs) that provide free or discounted medications to qualifying patients.

"There are tons of patient assistance programs out there," explained David Chen, R.Ph., director of ASHP's section of home, ambulatory, and chronic care practitioners. "Knowing where to get started is a real issue. Historically, PAPs have not been an easy resource to access or to use."

ASHP's answer to the questions and problems that plague would-be PAP users is the Patient Assistance Program Resource Center, http://www.ashp.org/pap/, launched in early March. PAPRC is a joint effort between ASHP and the Health Resources & Services Administration Pharmacy Services Support Center (PSSC) at the American Pharmacists Association.

PhRMA's program is backed by more than 50 patient advocate and community groups as well as the National Association of Chain Drug Stores. PhRMA is supporting PPA with a national print and broadcast advertising campaign that industry insiders said would cost $30 million this year alone. "It doesn't do anybody much good to research and develop new medications if people can't get them," said PhRMA spokesman Jeff Trewhitt. "We will help resolve the access and affordability problems for millions of patients."

For drugmakers, the payoff is higher drug utilization and profits. PPA is designed to boost use of PAPs, which increases use of free or heavily subsidized products. The program also directs potential patients to private and government assistance programs. Greater enrollment in Medicare, Medicaid, drug discount cards, and other programs boosts sales and profits. Once Medicare Part D enrollment opens, PPA will help potential recipients sign up for coverage.

About 46 million Americans are without health insurance, Trewhitt noted, and the number is rising annually. Uninsured patients incurred nearly $41 billion in uncompensated care in 2004. According to 2003 Institute of Medicine estimates, 18,000 uninsured adults die annually because they are unable to obtain appropriate care, including drug therapy.

Drugmakers have offered PAPs for decades, Trewhitt said, but the programs have not always been well publicized. When patients and providers manage to find assistance programs, they are seldom easy to use. Despite those access barriers, PAPs created by drugmakers have been growing dramatically. According to PhRMA, industry-sponsored PAPs filled 13.4 million prescriptions in 2002, 18.2 million in 2003, and 22.1 million in 2004.

PAP eligibility differs by program, but most require recipients to be without health insurance coverage and earn less than 200% of the federal poverty level. For 2005, that equates to $19,140 for a single person in the continental United States, $25,660 for a couple, and $38,700 for a family of four. Income cutoffs are higher in Alaska and Hawaii.

At last count, Trewhitt said, about 29 million Americans meet both income and noninsurance criteria. Only 6.6 million of the potential patient pool were enrolled in a PAP last year. Enrollment in other assistance programs is also low. Of the 7.2 million Medicare recipients who qualify for drug discount cards sponsored by drugmakers, about five million are not enrolled, he said.

ASHP and PhRMA are trying to boost both numbers. The two groups have been planning and developing their PAP portals independently, but came up with very similar results. Both created a one-stop shop for information and hands-on help to access the same pool of about 275 PAPs.

Roughly 150 programs are operated by drug manufacturers, according to PhRMA. The balance are federal, state, and local government programs such as Medicare and Medicaid, or private assistance plans. The biggest difference between the two portals is the intended audience. PAPRC is designed for pharmacists, said PSSC senior director Diane Goyette, while PPA is targeted at the general public.