Patient Assistance Programs

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Patient Assistance Programs

• Richard J. Sagall, MD
• 120 Western Ave
• Gloucester, MA 01930
• 215-625-9608
• www.needymeds.com
• richsagall_at_needymeds.com

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The Problem

• Over 45 million Americans have no health
  insurance
• 15.2 percent of Americans
• In 2002, the number of uninsured rose by 2.4
  million
• In 2003, the number of uninsured rose by 1.4
  million, the third year in a row this number
  increased
• Reuters 9/30/03 (23)
• American Medical News 9/13/04 (14)

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The Problem

• 47 of Americans find it difficult to pay for
  health care
• Gallup Poll, 2004

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The Problem

• Many physicians have no idea of the price of the
  medicines they prescribe
• Many patients are too ashamed to tell their
  doctors they cant afford their medicines

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The Problem

• Nearly 82 million Americans - about 1/3 of all
  Americans - lacked health insurance at some time
  in the last two years.
• Most lacked health insurance for more than 9
  months
• AP 6/04

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The Problem

• Percent of working adults with annual incomes of
  20-40,000 without health insurance for at least
  part of the year
• 28 in 2001
• 41 in 2005

The Week, 5/12/06
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The ProblemDrug Prices

• Drug prices rose nearly 3 times general inflation
  over the past 4 years
• In 2003, drug makers increased the wholesale
  prices of the 200 drugs mostly commonly
  prescribed for people over 50 by 6.9 - three
  times the rate of inflation for that year of 2.2
• AARP, 2004, in CBS MarketWatch, 5/26/04

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The ProblemDrug Prices

• 2005 - 6 increase in cost of brand-name drugs
  most commonly used by the elderly - twice the
  rate of inflation.
• 6th year in a row that drug costs rose faster
  than the rate of inflation
• The Week, 4/21/06

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The ProblemHealthcare Costs

• 48 of Americans have cut back on savings due to
  the rising costs of healthcare
• 30 have trouble paying other bills
• 26 have used up all their savings
• 18 have trouble paying for food, heat, and
  housing
• 2004 Health Confidence Survey, Employee Benefit
  Research Institute

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Who Are The Uninsured?

• Kaiser Foundation Survey
• 75 of the uninsured work full time
• 50 of small businesses dont offer health
  insurance
• Many workers cant afford to pay health insurance
  premiums

BusinessWeek, 5/24/04
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Who Are The Uninsured?

• In 2000, 29 of large and medium sized companies
  paid 100 of health insurance premiums
• In 2004, 17

Hay Group, in The Week, 4/1/05
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Who Are The Uninsured?

• Number of people buying their own health
  insurance
• 900,000 in 2000
• 17,000,000 in 2003
• Employer-based Coverage
• 164,200,000 in 2000
• 159,000,000 in 2003

BusinessWeek, 10/10/05
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Aging and Prescriptions
Medical Economics, 10/7/05
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Aging and Prescriptions
45 - The percentage of all prescription
medications consumed by senior citizens
Health and Productivity Magazine, Vol 5, 2, May,
06
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Prescription Facts - 2002

• 103 Billion - Annual cost of outpatient
  prescriptions
• 1,102 - Average annual medication cost for
  people 65 and older
• 485 - Average annual medication cost for people
  under 65
• 16 of all medical costs are for outpatient
  prescriptions
• Medical Economics, 10/10/03

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Prescription Facts - 2004

• 235.4 Billion - Annual cost of outpatient
  prescriptions
• 8.3 - Increase from 2003
• 476 billion - Annual spending on restaurant
  meals
• IMS Health, Inc., 2005 and National Restaurant
  Association, 2005

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Prescription Facts
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Medicare Part D
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Medicare Part D

• 250 - Annual Deductable
• 25 for 251-2,250
• 0 for 2,251-5,100
• 95 for costs over 5,100

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Medicare Part D

• BUT
• Enrollment fee of 40-50 per year
• Monthly fee of around 40 per monthMedicare Part
  D

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Medicare Part DConfusing and Complicated

• Programs run by private insurance companies
• In some areas over 50 programs to choose from
• Each program has a different formulary
• Formulary may change (60 day notice to
  enrollees)
• Enrollees can change program only once a year
• TrOOP (True Out Of Pocket) costs are confusing
• Enrollees medications may change

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Discount Prescription Programs

• Programs Closed - Medicare Part D
• Lilly Answers Card
• Orange Card
• Together Rx Card
• UShare Card
• Rx Saving Card

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Discount Prescription Programs

• Merck Prescription Discount Card
• No prescription coverage
• Enrolling in Part D disqualifies
• Covers 11 products
• 15-40 discount

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Discount Prescription Programs

• Together RX Access Card
• 12 Companies
• No Rx Coverage
• Ineligible if on Part D
• Income
• 30,000 for single
• 40,000 for couple
• Discount (25-40) varies according to
• Company
• Drug

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What Are P.A.P.s?

• Usually run by pharmaceutical companies or their
  contractors
• Provide medicines to indigent people at no or
  low cost
• Usually not meant to supply medicines in an acute
  situation

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What Are P.A.P.s?

• Have varying levels of complexity
• Some employ reimbursement specialists
• Some require original forms - others will accept
  copies
• Physician involvement varies
• Usually under marketing budget

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What Are P.A.P.s?

• The only generalization that can be made is that
  every program is different!

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Generic Programs

• Rx Outreach (run by Express Scripts)
• Xubex (a private company)
• 250 of Poverty Level
• 20-30 for a 3 month supply
• Over 100 drugs

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How Much Is Given Away?

• Each year P.A.Ps help over 6 million people
• Fill 36 million prescriptions
• Have a wholesale value of 4.2 billion
• Eleven-fold increase since 1997

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Increase In Patients Helped

• 1996 836,541
• 1997 1,147048
• 1998 1,487,302
• 1999 1,910,836
• 2000 2,441,627
• 2001 4,028,046
• 5,461,510
• 6,200,000

PhMRA, 2004
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Prescriptions Filled

• 1996 1,841,789
• 1997 2,004,385
• 1998 2,773,213
• 1999 4,832,763
• 2000 8,049,123
• 2001 10,634,125
• 14,126,125
• 18,000,000
• 22,000,000
• 2005 36,000,000

PhMRA, 2006
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Wholesale Value

• 1996 Not available
• 1997 374,529,354
• 1998 500,078,242
• 1999 773,726,423
• 2000 1,110,900,329
• 2001 1,805,154,305
• 2,307,381,122
• 3,400,000,000
• 4,170,000,000
• 2005 5,000,000,000

PhMRA, 2006
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Comparison

• 4 billion - PAPs
• 11 billion - Samples
• 250 billion - Prescription Sales

Philadelphia Inquirer - 10/20/04 2/23/06
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Why Dont Clinics Use PAPs?

• Requirements change without notice
• Income documentation requirements unrealistic for
  indigent patients
• Limited to US residents or citizens
• Frequent reapplication required
• Applications differ among companies
• Lengthy or complicated phone pre-authorization

Medicine for People in Need Program/Public Health
Institute, 2004
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Types of Websites

• Online completion of forms
• RxHope(http//www.rxhope.com)
• LimitationsLimited drugs availableNeed to enter
  a lot of information onlineStill need to
  manually complete some information and
  physician signature

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Types of Websites

• Sites That Complete the Forms for Patients
• Health Med Assist and others(http//www.healthmed
  assist.com)
• LimitationsCharge for each form
  completedPhysician still needs to complete some
  forms, sign them, etc.

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Types of Websites

• Information Sources
• Pharmaceutical Research and Manufacturers of
  America (http//www.pparx.org/)
• Robert Wood Johnson Foundation (http//www.rxassis
  t.com)
• NeedyMeds (http//www.needymeds.com)

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NeedyMeds

• Began in fall, 1997
• Over 7.9 million hits since inception
• Over 7,500 homepage visitors/weekday
• Over 60,000 total page views each weekday
• Designed for ease of use
• Regular updates - companies contacted every 1 to
  3 months

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NeedyMeds

• Information on over 370 companies/programs
• Information on over 2700 drugs and dosages
• Over 155 downloadable forms
• 200 state programs
• 225 local programs
• 400 disease specific programs
• Other useful information
• All information free

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NeedyMedsOther Services

• Informational Brochure
• PAP News
• Update Mailing List

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Benzodiazepines on PAPs

• Alprazolam
• Chlordiazepoxide
• Clonazepam
• Clorazepate

• Diazepam
• Flurazepam
• Lorazepam
• Temazepam

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Questions???