{"id":56942,"date":"2023-02-07T09:30:31","date_gmt":"2023-02-07T14:30:31","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=56942"},"modified":"2024-10-25T10:53:15","modified_gmt":"2024-10-25T14:53:15","slug":"patient-assistance-programs","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/patient-assistance-programs\/","title":{"rendered":"What are patient assistance programs?"},"content":{"rendered":"

The rising cost of living in the United States is making it harder to pay for prescription medicines, even among individuals with health insurance. For the uninsured or underinsured, high drug costs may mean forgoing a much-needed medication altogether. In fact, more than <\/span>1 in 4<\/span><\/a> Americans struggle to afford their meds, according to a poll conducted by the Kaiser Family Foundation. For some patients, that means skipping doses or simply not taking a prescribed drug, a dangerous situation for those with serious health conditions. <\/span><\/p>\n

That’s where patient assistance programs (PAPs) can help. PAPs are programs that help people with no health insurance and those who are underinsured pay for their medications. Here’s how they work.<\/span><\/p>\n

How do patient assistance programs work?<\/span><\/h2>\n

If you can’t afford your medication, patient assistance programs may be able to help with prescription drug coverage. PAPs give patients without health insurance, underinsured individuals, and beneficiaries with government-funded insurance plans (like Medicare and Medicaid) discounts on their medication, says <\/span>Stella Bard<\/span><\/a>, MD, a board-certified rheumatologist in McKinney, Texas<\/span>. <\/span>Sometimes, the cost of a medication is covered entirely. <\/span><\/p>\n

Patient assistance programs are most often sponsored by specific pharmaceutical manufacturers to provide medication they manufacture to patients who are unable to afford their medication, says <\/span>Brian Staiger<\/span><\/a>, Pharm.D., a clinical pharmacist in Buffalo, New York, and owner of <\/span>Hello Pharmacist<\/span><\/a>. PAPs are also sometimes offered by government agencies and nonprofit organizations<\/span>.<\/span> “Typically, these <\/span>programs provide medications at little or no cost to those who qualify based on income and insurance status,” Dr. Staiger says.<\/span><\/p>\n

Unlike <\/span>copay cards<\/span><\/a>, which are offered by pharmaceutical companies to offset the price of brand-name drugs for patients with commercial insurance, PAPs are intended for those who are uninsured or underinsured and need financial assistance, explains Dr. Staiger. “PAPs all work in the same way, although there are differences depending on the specific program,” he says.<\/span><\/p>\n

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  1. A patient or their healthcare provider (in most cases, both) will need to fill out a form to initiate enrollment. <\/span><\/li>\n
  2. Eligible patients will be required to provide documentation of financial and insurance information to show they have no means of obtaining the medication without assistance. <\/span><\/li>\n
  3. The healthcare provider very often has to provide evidence of their diagnosis and other patient records as requested.<\/span><\/li>\n<\/ol>\n

    “After the application is reviewed and approved, the medication is usually shipped directly to the patient’s home or their healthcare provider’s office through contracted pharmacies,” explains Dr. Staiger. He adds that in most cases, the medication cannot be picked up at your local pharmacy. <\/span><\/p>\n

    Patient assistance program benefits<\/span><\/h3>\n

    The primary benefit of PAPs is reduced or no-cost medication to qualifying individuals, says Dr. Staiger, adding that additional benefits may include:<\/span><\/p>\n