We categorized programs into pharmaceutical manufacturer–sponsored programs government-sponsored programs, such as state Medicaid programs and third-party programs, such as those offering pharmacy discount cards.įor drug company–sponsored programs, we searched materials available on the PPA Web site to describe their characteristics across the following domains: (1) the number and names of covered medications (2) the type of benefit, classified as patient assistance (that is, programs that provide medications with or without copayments), copayment or coinsurance assistance (that is, programs that pay the copayments or coinsurance under patients’ existing insurance plans), patient and copayment assistance, rebates, or other (3) the amount of copayments or coinsurance required, if any (4) the enrollment criteria regarding whether and under what circumstances patients can have other drug coverage-in particular, Medicare Part D (5) the financial and clinical eligibility criteria and the documentation required to substantiate self-reported information (6) the length and readability of the application (7) the duration of coverage and the process of prescription and program renewal and (8) the way in which medications are delivered to patients (that is, via their physicians, health care facilities, pharmacies, or mail). We searched the PPA Web site ( ) in July 2007 for programs offering discounted or free medications to patients. Accordingly, we evaluated the PPA Web site and surveyed programs run by brand-name drug manufacturers. 9 A greater understanding of how many programs exist, the benefits they provide, their eligibility criteria, the application process, how patients receive medications, and the number of patients who have been helped by individual programs could help clarify PAPs’ role in providing access to essential medications for patients with inadequate drug coverage. There is limited published information describing the benefits offered by drug company–sponsored PAPs. 7 Pharmaceutical Research and Manufacturers of America (PhRMA) estimates that its Partnership for Prescription Assistance (PPA) program, which it launched in 2005 to bring together a variety of private and public programs, has helped 5.5 million Americans. These programs have been advocated as a “safety net for millions of needy Americans who are not eligible for comprehensive assistance programs and unable to afford their medications.” 6 Further, a majority of nonprofit clinics that serve largely un- and underinsured patients direct scarce resources toward helping their patients obtain medications through PAPs. Patient assistance programs (PAPs) offered by pharmaceutical manufacturers provide eligible patients with access to brand-name medications at little or no cost. 4 Cost-related medication underuse has important implications for health and paradoxically might increase overall health costs, because care that is potentially preventable by the use of effective medications could cost more than the drugs themselves. 3 Even for people with coverage, such as Medicare Part D, patients face cost sharing through tiered copay-ments or coverage gaps, and these out-of-pocket costs could reduce their use of prescribed medications. 2 And although many people obtain drug coverage through employer-based or governmental programs, such as Medicaid, sizable numbers of adult Americans have no such coverage whatsoever. 1 More than a quarter of patients have not filled a prescription or have reduced a prescribed dosage because of its high out-of-pocket cost. One-third of Americans of all ages and two-thirds of the elderly report difficulty paying for medications. The ability of Americans to afford prescription medications is a major public health issue.
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