PAP and Healthcare Reform: What Changed… and What Didn’t

PAP and healthcare reform

PAP and Healthcare Reform: What Changed… and What Didn’t

Ahead of the staggering changes brought about by the Affordable Care Act (ACA), many predicted that the need for manufacturer-funded Patient Assistance Programs would decline as patients received coverage from new government sources. Now that we are well into the ACA’s implementation, it’s clear how healthcare reform is impacting PAPs. Here’s a look at what changed and what hasn’t.

What Changed
More funding sources – Healthcare reform spurred the creation of additional payers and the focus on healthcare led to the development of more foundation-generated funds. This created opportunity, but also made things more complicated. More than ever, patients need guidance to identify the right resources for their needs.

Increase in the number of underinsured – While healthcare reform reduced the number of uninsured patients, it also expanded the group of underinsured ones – or those patients who don’t have enough health insurance to cover their needs. In one PAP, before healthcare reform, 167 patients who were denied access to the program because of private insurance were ultimately allowed onto the program because their insurance didn’t fully cover their prescription drug needs. In contrast, in 2014 the same program accepted 2,600 patients who were initially denied due to existing coverage.

Temporary assistance – We’ve seen an increase in adoption of bridge programs — or temporary assistance programs — whereby patients qualify for free product while benefit specialists work through coverage issues or seek alternative coverage options for patients. This allows patients to get the needed medications in a timely manner and on a short-term basis. Patients transition off of the program when their coverage becomes available.

What Didn’t Change
The need for Patient Assistance Programs – PAPs are not going away. It’s more important than ever to have a robust alternate funding program to ensure these patients are covered in the most cost-effective way possible. Our proprietary system allows our PAP team to instantly search nearly 400 funds to ensure patients are directed to the best resource. More than 12% of our alternate funding searches result in a referral.

UBC’s expertise – Our breadth of experience gives us a panoramic view of the patient assistance space. We leverage this knowledge to consult with clients on providing PAP services that fulfill their goals and provide the best support to patients. Check out our infographic to learn more.

Shifts in the political landscape will continue to impact how healthcare is provided to Americans. Whatever changes come, our PAP team will be monitoring these updates and actively partnering with our clients to provide continued support to patients. Contact us to put our team to work for your patients.