Patient assistance programs (PAPs) are evolving in response to increasingly restrictive formularies and payer criticism. Patient Assistance Programs: Payer and Pharma Perspectives is a report that gives unique insight into payer attitudes and opinions on the future of PAPs.
As the numbers grow for Americans without private health insurance, the answer for many has been patient assistant programs. But as the pharmaceutical industry moved towards co-pay and coupon models, payers have been increasingly resistant and critical of the new PAP schemes.
FirstWord’s Patient Assistance Programs: Payer and Pharma Perspectives report offers an insightful and thorough examination of the current PAP environment, evaluating payer moods, attitudes and strategies.
Based on in-depth interviews with national payers and pharmaceutical industry experts, the report is an important tool for finding the optimal strategy and approach to the development and implementation of PAPs.
Get Answers to Critical Questions
Key Quotes from Contributors
“Years ago, patient assistance program means programs that help out patients who were below a certain level on the poverty line, because they couldn't afford their medications. Now patient assistance program means I don't care what tier my drug is on, I'm going to give somebody a co-pay card so they can get my drug irrespective of how the payer is handling those drugs.”
Pharmacy Director, government health plan
“My goal if somebody needs an oral oncology drug is not to have them take ,500 out of their bank accounts for them to get the drug. My argument with the manufacturer would be don't charge 0,000 for the drug and stop giving away ,500 coupons.”
Chief Medical Officer
“It doesn't make me feel anything if they don't show a willingness to change the programme and work with me on something. If they just want to keep running the programme and ramming it down my throat, I feel pretty bad about that. If they want to work and look at a collaborative approach, it makes me feel a lot better.”
Executive Vice President PBM
“I think that these kinds of assistance programs, from the company's perspective, they realise are critical in terms of maintaining trust with the regulators and maintaining trust for the patient. They know that there has to be a fine balance between making sure people get access to the drugs, especially in countries which contributed the development of the drug.”
Global Medical Director, major pharmaceutical company.
Table of Contents
for Patient Assistance Programs: Payer and Pharma Perspectives
1.1.PAPs were originally recognised as a charitable move by industry to provide access for needy patients
1.2.The introduction of co-payment cards changed the way in whichPAPs are perceived by payers
1.3.Payer engagement in the development of PAPs is limited
1.4.PAPs that deliver on outcomes will be favoured in the future
2.Research objectives and methodology
3.Patient Assistance Programs overview
3.1.What are patient assistance programs?
3.1.1.Why are patient assistance programs needed?
3.2.Different types of patient assistance programs
3.2.1.Non-industry patient assistance programs
3.2.2.Eligibility and enrolment requirements
4.Payer opinions on Patient Assistance Programs
4.1.Payers recognise PAPs deliver benefits to those patients in financial need
4.1.2.The high cost of specialist products means patient assistance
is often necessary
4.1.2.Payers are concerned about patients who would
“fall between the gaps” without PAPs
4.2.Payers have several concerns with patient assistance programs
4.2.1.A key criticism is that PAPs are being used to avoid formulary restrictions
184.108.40.206.Sampling is also seen in a negative light
220.127.116.11.Some payers are concerned that patients are being misled by PAPs
18.104.22.168Some payers feel that, in the longer term, PAPs are more costly for the health system
4.3.Payers are cynical as to the genuine reasons for PAPs
4.3.1.PAPs are seen as a way to ensure product uptake
4.3.2.Several payers believe PAPs are a “backdoor” route to market access
4.3.3.PAPs are also viewed as a mechanism of maintaining inflated prices
5.Industry opinions on Patient Assistance Programs
5.1.There are a number of key benefits that pharmaceutical companies gain from PAPs
5.1.2Ensuring widespread patient access to drugs is a fundamental reason
for implementing PAPs
5.1.3.PAPs are now seen as essential in order to maintain competitiveness
in increasingly crowded markets.
5.1.4.The patient benefits that PAPs deliver are also a driver for industry
22.214.171.124.Compliance is a driver for industry – but for different reasons to payers
5.2.The use of products that would otherwise be limited is seen as the
payers’ key objection by industry
5.3.Patient and competitive benefit are seen as the main reasons for
pharmaceutical companies running PAPs
6.1.Payers have limited decision-making responsibilities for PAPs
6.2.Pharmaceutical companies will inform payers of their planned PAPs
6.3.Payers need a basic range of information about PAPs
6.4.Flexible and ongoing interaction would be useful for payers
6.4.1.PAPs that provide information on outcomes would be favoured
7.1.The numbers of PAPs, and patients accessing them,
is expected to continue to grow
7.2.Payers expect a rise in regulation around PAPs
7.3.Continued distrust of PAPs will be the main challenge faced by manufacturers
7.4.Payers expect the management of PAPs to become more challenging
7.4.1.The provision and analysis of data and outcomes is vital for payers
7.5.Industry also expects PAPs to change in the future
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