It is a choice no one should have to make: pay rent and buy food or get prescriptions filled. Yet all to often, it is a choice many Americans have to make.
Over 40 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 still don’t have the money to pay for 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 pharmaceutical companies have PAPs. The manufacturers who have these programs do so for various reasons: Some believe that they have a corporate social obligation to help those who can’t afford their products while others believe PAPs are a good marketing tool. As one PAP director once told me, many people who can’t afford their medicines eventually go on to obtain some type of coverage. And when they get this coverage, the companies want the patient to continue using their products.
In 2002, PAPs helped over 5 million people. The programs filled 14.1 million prescriptions with a total wholesale value of over $2.3 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 these 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 patient 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 and some programs require the doctor complete a portion of the application.
Most send the medicines to the doctor’s office for distribution to patients, while others send the medicine to a pharmacy. A few send a certificate that the patient gives directly to their pharmacist. Some patients need drugs for a long time and 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 are available through the program and at what dosages. Some include many or all of the medicines they make, while others include only a few. Sometimes different dosages of a certain medication will be available at various times. The reasons for their decisions are not something they make public. None include generic medicines in their programs.
HOW TO LEARN ABOUT PAPS
As your doctor or pharmacist may not know about PAPs, the best place for information is the Internet. There are a number of sites that have information on these programs. Many pharmaceutical company websites also have information about their patient assistant programs on their websites, but often this information is buried and difficult to locate.
TYPES OF WEBSITES
There are many websites with information on patient assistance programs, including NeedyMeds.com, RxAssist.org, and HelpingPatients.org. There is no charge to access the information and these sites don’t have a PAP of their own nor do they help individuals apply to get their medicines.
NeedyMeds, a website I co-founded, is self-funded by sales of manuals and other items.The Robert Wood Johnson Foundation supports RxAssist. 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; it only has information on PhRMA members programs.
There are also a number of sites that charge to help people learn about patient assistance programs and complete the application forms. The charges vary as does the quality of the services provided. Some offer a money-back guarantee if they can’t get your medicines.
HOW TO USE NEEDYMEDS
I will describe how to use the NeedyMeds site as it is the one I know most about. RxAssist and HelpingPatients contain similar information.
There are two ways you can check to see if your medicines are available on a patient assistance program.One is to click on the drug list, which brings up an alphabetical list of all the drugs currently on PAPs. Find the medicine you take and click on its name to bring up the program page. You can also search by drug manufacturer.
On the program page,you will learn about the specifics of the PAP, including the qualification guidelines, the application process, the information you need to supply, and what your doctor must complete. In addition, you will learn if there is 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.)
Once you get the information you need, it is then 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 the lack of physician cooperation. Patients often complain that their physicians refuse to complete the forms or charge to do it. If you run into this situation, here are a couple of suggestions:
1. Make sure you have completed everything on the form you can. Not only should you complete the applicant’s section, but anything else you can do. This may include the physician’s name, address, and phone number.
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 or her help, you won’t be able to obtain the medicines you need. Be blunt.
6. If all else fails, you may need to find a physician more sympathetic to your situation 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 people who can help those not familiar with their use.
Patient assistance programs are not the best solution to the problem of the high cost of medication. However, it is the best solution for some people. Millions of people use PAPs to get the medicines they need but can’t afford. If you can’t afford your medicines, a patient assistance program may be able to help you.
Richard J. Sagall, MD, is a board certified family physician practicing in the Philadelphia area. He co-founded NeedyMeds.com and continues to run the site, where he can be reached via email.