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New white paper outlines how copays can benefit federally-funded prescription programs
In the world of copay programs, which are currently in the $5-billion range in total US industry funding and, by most accounts, continuing to rise, there are numerous hurdles between money that the biopharma industry would provide, and patients who can use the copays to offset out-of-pocket expenses. One of these hurdles is the limitation that they cannot be used for patients on Medicare, Medicaid or other publicly funded programs (HHS considers them to be an illegal financial inducement to patients). But an existing alternative, the so-called “charitable PAPs” (Prescription Assistance Programs) offer an alternative.
According to a white paper just published by HealthWell Foundation (Gaithersburg, MD), that organization has a "modified" authorization from the Office of Inspector General (OIG) of HHS—the only charitable PAP with this explicit modification, according to HealthWell—allowing it to establish Medicare-only funds. The primary requirement is that the assistance be offered for a disease state for which there are at least two medications, sold by two distinct manufacturers. Other charitable PAPs provide similar flexibility, but Healthwell promotes its programs as not only meeting legal requirements, but also being highly efficient in delivering assistance with minimal overhead.
Krista Zodet, VP at HealthWell, says that the Foundation is on track to meet its annual fundraising goals this year (last year it collected and disbursed $144 million), “but the need continues to rise” as copay requirements from insurers tighten, and millions continue to be un- or underinsured. Copay assistance continues to generate friction between industry and pharmacy benefit managers (PBMs), who look on the assistance as a way to get around the tier levels or formulary restrictions that they impose on health plans. But Zodet says that “we’re not involved” in that dispute; “in fact, we have insurance industry executives on our board and they have not expressed that concern.”