Originally published by our sister publication Specialty Pharmacy Continuum

 

By Karen Blum
Only 21% of U.S. adults and 24% of adults with a chronic condition report being extremely or very familiar with financial assistance programs available to help patients in need cover the cost of prescription medications, according to the results of a new poll from the Patient Access Network (PAN) Foundation, a national patient advocacy organization. 

These programs include pharmaceutical patient assistance programs, charitable foundations, federal programs and more.

In addition, most U.S. adults (84%) and patients with chronic conditions (87%) said a range of resources would help them understand and navigate financial assistance programs and healthcare plans, according to the report. While about 37% said they needed assistance covering out-of-pocket costs, about 41% of those individuals did not end up receiving assistance. These results were presented this spring at Asembia’s AXS25 Summit in Las Vegas.

The report summarizes the results of a national online survey conducted by The Harris Poll from March 4 to 6 this year among 2,046 adults, 1,273 of whom have chronic conditions.

“It’s clear that people have challenges navigating and understanding their healthcare plans,” Amy Niles, the chief mission officer for the PAN Foundation, told Specialty Pharmacy Continuum after the meeting. In addition, whether she is addressing conference audiences, patient groups or healthcare providers, she remarked that “what comes out time and time again is just general low awareness around financial assistance programs.” For example, she said, “there’s millions of people out there who could qualify for assistance through [the federal] Extra Help program [for Medicare beneficiaries], but they haven’t applied.

“I hate to say I’m not surprised,” Ms. Niles added. “People don’t dive into their [health] plans until they need something. For example, if diagnosed with a chronic disease, they now have to understand what their plan covers, including medications. And, in general, plans are confusing to understand. They’re complex, and they use terminology that people have a hard time understanding.”

Conversations between patients and healthcare providers around medication assistance and treatment affordability don’t happen as often as they should, she said, either because of time constraints during appointments or lack of knowledge on the part of the provider or the patient. There is a clear need for creating educational resources for patients and providers and increasing general awareness about available financial assistance, Ms. Niles said.

The most requested resources identified through the national poll included lists of questions to ask healthcare providers and insurance plans; a case manager who could help with financial assistance; and simple guides explaining key terms, benefits and eligibility requirements.

In other survey findings:

•   Only about two in five U.S. adults (37%) and adults with chronic conditions (38%) said they understand their healthcare plan very well. Nearly one in five (18%) said they don’t understand their prescription drug coverage, and about two in five said they don’t know if their plan has an alternative funding program vendor relationship in place (41%) or what prescriptions or treatments require step therapy (40%).
•   Only one in five adults (21%) report strong familiarity with financial assistance programs. About two in five adults (40%) had never heard about independent charitable assistance foundations or pharmaceutical patient assistance programs before the survey.
•   People with household incomes of less than $50,000 reported lower familiarity with most financial assistance programs than those with incomes of $100,000 or more. The internet and healthcare providers are the first places people turn to for financial assistance information.

Confusion Leads to Delayed Care

Confusion about health plans led to more than three in 10 adults (35%) and patients with chronic conditions (42%) to delay or avoid care, while lack of coverage led to three in 10 adults (28%) and patients with chronic conditions (35%) to delay or skip taking prescription medications.

Most U.S. adults (84%) and patients with a chronic condition (85%) report experiencing some type of impact because of challenges using their healthcare plans.

Specialty pharmacy plays a critical role in securing financial assistance for patients in need, said Sheila Arquette, RPh, a panelist at the meeting and the president and CEO of the National Association of Specialty Pharmacy.

“While some voices in the industry claim that specialty pharmacy isn’t truly ‘special,’ the reality is, it absolutely is,” Ms. Arquette said in an interview. “In addition to conducting thorough medication reviews, counseling patients on safe and effective medications use, managing side effects, dispensing prescriptions, and coordinating with care teams, a key differentiator of specialty pharmacy is its commitment to addressing financial toxicity—working diligently to secure financial assistance for patients who face the high cost of these complex therapies.”

Specialty pharmacies have team members dedicated to addressing affordability issues and working closely with manufacturer-sponsored programs, Ms. Arquette added. “But some federal healthcare programs, like Medicare, prohibit the use of these programs, so these pharmacies also partner with charitable foundations like the PAN Foundation for help. Specialty pharmacies play a critical role in minimizing the financial strain some patients may experience.”

There has been a spotlight on affordability this year with the introduction of the Medicare Part D cap and a new program called the Medicare Prescription Payment Plan allowing Medicare beneficiaries to smooth or spread out their out-of-pocket medication-related costs throughout the year, she said. “It’s deeply troubling that so many patients are unaware that help is available. We often hear heartbreaking stories of individuals forced to choose between essentials like food, heat or the medications they need—and no one should ever have to face that kind of decision.”

The PAN Foundation offers patient financial assistance and has a number of educational resources available online for providers and patients. Topics include Medicare, alternative funding programs and navigating financial assistance. There also are resources to help patients cover non–medication-related out-of-pocket healthcare expenses such as transportation, Ms. Arquette said.

Ms. Arquette and Niles reported no relevant financial disclosures.