Major health care industry trends are creating a challenge for the management ability of hospital pharmacies for the patient assistance programs (PAPs). For assisting with the prescribed medicines to the uninsured patient without hampering their budget, hospital pharmacies should take the desired steps to go along with the trends of the health care industry.
Many patients cannot afford the expensive medicines. That’s why drug manufacturers provide PAP (patientassistance program) to help such patient to get their products at an affordable price. They generally assist the patient in two ways:
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Replacement drugs
In this type of PAP program, the needy patient will get the drug at free of cost in the form of pharmaceutical donations from the hospital pharmacy and the manufacturer will replace the drugs to the hospital pharmacy without any additional charges.
Co-payment assistance
The help can be given in the form of co-insurance and co-pays. In this case, the manufacturer takes responsibility and fund the due balance to hospital pharmacy if the prescribed medications are out of budget for the patient.
There are three stakeholders are involved in a prescription assistance program, the patient, the manufacturer, and the hospital pharmacies. Drug manufacturer provides the medicine and maintains its market share. Hospital pharmacies ensure the cash flow and maintain the drug directory. Patients can get the prescribed medications even in a weak financial condition without undue hardship.
Challenges in PAPs
Drug expenses
The rate of traditional drugs is kept increasing. The price rise of drugs for the treatment of chronic and complex medical conditions is not an exception. In some cases, monthly expenses reach up to$10.000 and above so the patient has no option other than relying on the sponsored financial support provided by the manufacturers.
Expensive health plans
High deductible health plans (HDHPs) increase the expenses of a patient so that their ability to pay for the treatment gets affected. HDHPs is a quite major challenge for PAP because it has shifted to the patient based financial system from a payer based financial system.
Level of benefits of the prescribed medication
The structure of health plan benefits is a bit complicated with several terms and conditions. There are many tiers has involved in the prescribed drug coverage. Different drug formulary has its deductible levels and co-pay.
Value-added care
Effective medication should be the primary mission of PAP. If we see from the profit and loss point of view a pharmacy is not getting anything by donating the expensive medicines for free. If we see the health point of view of the population, the pharmacy is responsible to provide drugs to all mankind. And that is essential for effective PAP.
Uninsured rates
The percentage of Uninsured rate is declining due to awareness of the Patient Protection and Affordable Care Act. But still millions of people have left without benefits and insurance who have urgent need of prescribed medicines for their critical health. And also many people with health coverage are not able to get the benefits because of their ignorance and lack of understanding. Besides this, a big portion of the population is not aware that for which medical conditions full coverage cannot be claimed.
Approaches and suggestions to improve PAP
Here are a few suggestions you can implement for the optimization of patient assistance programs.
Awareness of technology
Technologies have provided PAP management tools for its efficient optimization. With the help of robust tools, the database can be tracked and based on that information available at host system users can match the patient to PAP. The data includes information on the financial and clinical condition of patients, diagnosis, disease stage and severity, benefit level, insurance status, etc. The PAP tool helps to increase the reachability to each patient.
Conduct training programs
Hospitals and medical firms should raise the awareness of their staff about all range of prescription assistance program and its terms and conditions. They should make them understand the structure of each plan that these plans will be effectively applied to eligible patients.
Proper assistance of professionals
Without the assistance of professionals, the training, technology and education requirement for effective management seems complicated. So it is better to outsource a third party with technology infrastructure as well as clinical and financial expertise. Some providers feel that the involvement of a third party may cause extra cost and may also limit their direct interaction with the patient. These suspicions may be more than offset by enabling a large number of enrolment in PAPs.
Conclusion
The optimization of PAP is successful only when the most numbers of the patient can receive the prescribed medication without hampering the business of pharmacy and without draining the budget of patients. With dedicated time, expertise and focus on the successful optimization of PAP can be achieved.
