pLOG

2024-06-12

Pharmaceutical-Integrated Model of Patient Assistance Programs (PAPs)

Healthcare costs are continually rising, with the high price of cancer medications being a significant factor. This situation severely affects patient accessibility to treatments and exacerbates healthcare resource inequalities. Although pharmaceutical companies have established Patient Assistance Programs (PAPs) to improve affordability, disadvantaged groups often face delays, rejections, or treatment interruptions due to complex application processes and inconsistent eligibility requirements.

This study was conducted at Parkland Health (PH), a safety-net healthcare system in Dallas County, Texas, which provides free healthcare to uninsured patients with family incomes below 250% of the federal poverty level in an area with one of the highest uninsured rates in the nation.

The research team formed a "Medication Access Technicians" (MATs) team of licensed pharmacy technicians. They identified patients prescribed medications covered by PAPs in the electronic health system. If eligible, MATs completed and submitted the applications on behalf of the patients and tracked the approval process to ensure timely reviews. They also monitored refills and assisted patients with re-certifying their eligibility to prevent treatment interruptions.

The study period was from October 1, 2022, to September 30, 2023. During this time, MATs assisted 548 uninsured patients (90% Hispanic or Black) in applying for pharmaceutical assistance for 38 intravenous (IV) medications, with an estimated total value of $45.2 million, averaging about $79,000 per patient. The most expensive and frequently applied-for IV medications were pembrolizumab (96 patients, $8 million) and rituximab (159 patients, $5 million).

For oral medications, MATs helped 77 uninsured patients (84% Hispanic or Black) apply for pharmaceutical assistance for 20 different oral drugs, totaling approximately $8.8 million, averaging about $115,000 per patient. Dasatinib was both the most commonly requested and the highest value oral drug, with 24 patients receiving about $3.6 million in assistance.

However, researchers noted that 25 out of 38 IV medication assistance programs did not cover previously dispensed drugs, and 7 programs required applicants to be legal U.S. residents. These restrictions could limit the opportunities for some disadvantaged groups to receive assistance or cause treatment delays.

Despite PH investing around $620,000 annually in MATs' salaries, this patient assistance program significantly saved healthcare costs and prevented treatment interruptions, allowing medical resources to be allocated to other healthcare services.

The researchers urge relevant professional organizations and patient groups to advocate for pharmaceutical companies to expand eligibility criteria and reduce stringent restrictions, enabling more disadvantaged patients to access potentially life-saving treatments.

Overall, this study demonstrates how a dedicated pharmacy team can secure pharmaceutical assistance for underserved patient populations, thereby enhancing accessibility and equity in cancer care.


Reference:https://ascopubs.org/doi/10.1200/JCO.2024.42.16_suppl.e13724