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Pharmaceutical managed care professional, consultant to Wall Street, SME, public speaker, biomedical ethicist. Big Pharma, Major Payer, PBM, and Biotech experience; chronic pain sufferer, and PTSD survivor. Advocate for appropriate and compassionate care for chronic pain sufferers no matter what a person's situation may be. Passionate about patient access to medicine and appropriate/timely health care for every man, woman, and child. Committed to the prevention of suicide, interested in finding ways to bring drugs to market safely and more efficiently as well as committed to care that treats the entire patient - physical, mental and spiritual = the human condition. Deep connection with God and all of the gifts he's provided; special place in my heart for animals and children. Strong belief that while developing employees you expose their greatness as well as your own! Fascinated by the changing healthcare environment every day!

Patient Assistance Programs and Healthcare Reform!

The U.S. Supreme Court is expected to rule on challenges to the Affordable Care Act in June. In the meantime, states are required to follow the timetable set by the  Affordable Healthcare Act and have healthcare exchanges fully operational by Jan. 1, 2014

A healthcare exchange is described as “a government-regulated marketplace of insurance plans, available at competitive rates to those without employer-sponsored health coverage and available to small businesses. States are also required to develop a package of essential benefits that will be offered by health plans operating on the exchanges.”

But what will happen to individuals that still end up “underinsured” after the healthcare exchanges are up and running? And what about individuals that fall into the group that will find that their mandated healthcare coverage cost exceeds 8% of their annual income?

Individuals struggling to pay for mandated coverage under a healthcare reform will be exempt from penalty if the cost for coverage exceeds 8% of their annual income.  Therefore, after PPACA many individuals will continue to find it difficult – if not impossible – to afford their prescription drug costs. No one knows for sure how many individuals will fall into the bucket of the “uninsured” or “under-insured” population after 2014, but you can just bet that patient assistance programs (PAP’s) will be taking up the slack!

Patient Assistance Programs (PAP’s) operate much like a safety net for uninsured and under-insured individuals and traditionally, those people fall in and out of PAP’s during a year – depending on the ebb and flow of their financial situation. However with the recent economic downturn, more patients are finding themselves needing the PAP’s on a regular basis and this trend appears to have no end in sight.

In fact, according to IMS “Data released April 4, 2012 by the IMS Institute for Healthcare Informatics indicates that fewer patients are visiting their doctors, and that those who do are cutting what they spend on prescriptions.” One has to wonder how good healthcare reform may be for all Americans given these statistics.

For now and well past 2014, you can count on pharmaceutical manufacturers to continue their PAP’s specifically to cover the entire cost of a drug to someone in need, or even just copay assistance if that’s all a patient needs to get them beyond a barrier to access.  According to rxassist.org which bills itself as the “web’s most current and comprehensive source for patient assistance programs” they offer “a comprehensive database of patient assistance programs, as well as practical tools, news, and articles so that health care professionals and patients can find the information they need. All in one place.”

Therefore if you find yourself in a position such that you are unable to afford your prescription drugs, go the pharmaceutical company’s website and look for a link for “Patients”, “Prescription Assistance”, or visit rxassist.org click on the “patients” section and search for programs by drug name. There’s plenty of help available to remove financial barriers to the pharmaceutical products you need to stay healthy. See also: There are Programs Available to HELP You Pay for Your Drugs!!


Physicians feeling pressure from patients’ financial problems


State health insurance exchanges explained

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Health insurance exchanges 101: Westport broker demystifies pending reforms

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