It’s a choice no one should have to make – pay rent and buy food or get prescriptions filled. Yet all too often it’s a choice Americans, particularly older Americans, have to make.
Nearly 50 million Americans have no health insurance, and millions more have limited coverage. Many Americans just can’t afford health care, and, if they can, they don’t have the money to buy their medicines.
Patient Assistance Programs
There is help available for many people who can’t afford their medicines. These programs, frequently called patient assistance programs (PAPs), are designed to help those in need obtain their medicines at no cost or very low cost.
Many, but not all, pharmaceutical companies have PAPs. The manufacturers who have programs do so for various reasons. Some believe that they have a corporate social obligation to help those who can’t afford their products. Others believe it’s a good marketing tool. As one PAP director once told me, many people who can’t afford their medicines now will go on to obtain some type of coverage. And when they do get this coverage, they will continue using the medication provided by the PAP.
In 2008, PAPs helped over 8 million people. The programs filled prescriptions with a total wholesale value of over $10 billion.
The Basics of the Programs
All PAPs are designed to help those in need obtain their medicines. Since each pharmaceutical company establishes its own rules and guidelines, all are different. All have income guidelines, but they vary considerably. Each company selects which drugs are available on their programs and how long a person can receive assistance.
How PAPs Work
Although no two programs are exactly the same, most require that the applicant complete an application form. The amount of information required varies. Some programs require detailed medical and financial information, others very little. All require a doctor’s signature. Certain programs require the doctor complete a portion of the form while others only need a signed prescription.
Most send the medicines to the doctor’s office for distribution to the patients, while others send the medicine to a pharmacy. A few send a certificate to the patient to give to the pharmacist.
Some patients need drugs for a long time. Most, but not all, programs that cover medicines used to treat chronic diseases offer refills.
What Medicines are Covered
The pharmaceutical companies decide if they will have a PAP and, if they do, which of their medicines will be available through the program. Some include many or all of the medicines they manufacture while others include only a few. The reasons for these decisions are not something they reveal.
There are a few programs that sell generic medications at a fixed price – usually $20 for a three-month supply. These programs are adding more drugs all the time.
Sometimes a medicine or a certain dosage of that medicine will be on a program, then off, and then back on again. Or one dose of the medicine will be on the program but a different dose won’t be.
How to Learn about PAPs
Your doctor is not the best source of information on PAPs. Surprisingly, many doctors don’t even know PAPs exist. The same applies for pharmacists. Many social workers know about the programs. Books in the library or bookstore on PAPs are probably outdated before they are printed.
The best place to learn about PAPs is the Internet. There are a number of sites that have information on these programs. Many pharmaceutical companies have information on their patient assistant programs on their websites. Unfortunately, it’s often difficult to find the page that describes their PAP.
Types of Websites
There are two types of websites with information on patient assistance programs. Three of these sites list information on patient assistance programs – NeedyMeds (www.needymeds.org), RxAssist (www.rxassist.org), and Partnership for Prescription Assistance (www.pparx.org). There is no charge to use the information. These sites don’t have a program of their own nor do they help people get their medicines.
NeedyMeds is a non-profit funded by donations, sales of software for managing PAPs, and other sources. The Pharmaceutical Research and Manufacturers of America (PhRMA), an association and lobbying group whose members include many of the larger pharmaceutical manufacturers, runs HelpingPatients.org, which has information on PhRMA members programs.
Then there are a number of sites that charge people to learn about patient assistance programs and complete the application forms. The charges vary, as does the quality of their services. Some offer a money-back guarantee if they can’t get your medicines.
How to Use NeedyMeds
Most PAP sites contain similar information. They differ in how they organize the material, the ease in accessing the information, and the timeliness of their data.
To use the NeedyMeds site you begin with the name of your medicine. There are two ways you can check to see if your medicines are available in a patient assistance program. One is to click on the drug list. This brings up an alphabetical list of all the drugs currently on PAPs. Find the medicine you take and clink on its name. This will bring up the program page.
On the program page, you will learn about the specifics of the PAP – the qualification guidelines, the application process, the information you need to supply, what your doctor must complete, etc. In addition, you will learn if there’s a downloadable application on the website or if you must get an application from the company. (Some companies accept copies of their application form while others require you complete an original.)
If you know the medicine’s manufacturer, you can click on the programs list. From there, you can click on the program you want to learn more about. That should bring up the information you need.
Once you have acquired the information, it’s up to you to complete the applications, get the necessary signatures, and send the form to the program.
A Few Tips
The most common problem patients encounter when completing the application forms is lack of physician cooperation. Over and over I hear from people whose physicians just won’t complete the forms – or charge to do it. I am asked what they should do.
Here are a few suggestions:
1. Make sure you have completed everything on the form that you can. Not only should you complete the applicant’s section, but anything else you can fill in. This may include the physician’s name and address, phone number, etc.
2. Bring all the information your doctor may need. For example, some programs require proof of income. If so, attach whatever documents are required.
3. Bring an addressed envelope with the appropriate postage.
4. Don’t expect your doctor to complete the form immediately. A busy doctor may not have time to read the form while you are in the office.
5. If you encounter resistance, tell your doctor that without his/her help, you won’t be able to obtain the medicines he/she is prescribing. Be blunt.
6. If all else fails, you may need to find a physician more sympathetic to your plight and willing to help you.
What if I Don’t Have a Computer
Many people without a computer can still use the information available on these websites. Nearly everyone knows someone with a computer – a family member, a neighbor, or a friend. Most public libraries have computers for public use and assistance for those not familiar with their use.
Patient assistance programs may not be the best solution to the problem of inability to pay for medication, but they can help many people. Millions of people use PAPs to get the medicines they need but can¹t afford. If you can’t afford your medicines, a patient assistance program may be able to help you.
Richard J. Sagall, M.D., practiced family medicine and occupational medicine for 25 years. He cofounded NeedyMeds and continues to run it. He can be reached via the website, www.needymeds.org. He lives in Gloucester, MA.