Patient Assistance Programs: Payer and Pharma Perspectives
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.
Key Takeaways
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.
Key Takeaways
- Gain insight into payer attitudes and strategies regarding the true cost of PAPs to the healthcare system
- Learn which factors influence payer decision making when it comes to supporting PAPs and how that can be leveraged
- Discover when pharma should engage with payers in the development and implementation of PAPS
- Learn payer attitudes on a range of key issues, including the value of measuring PAP impact on patient adherence and health outcomes
- Gain insight into how payers and industry experts predict PAPs will change in the future
- What factors would positively influence payer attitudes towards PAPs?
- As formularies become more restrictive, what does the future hold for PAPs?
- What do payers predict will happen with regards regulating PAPs?
- What are the key drivers of distrust among payers over PAPs and how can this be reversed?
- What can be done to increase data capture to improve quality of care?
- What is the industry view of PAPs, and how does this compare with the views of payers?
- Insight into payer criticisms and opinions on issues such as PAPs as ‘backdoor’ route to market access, ensuring product uptake and a mechanism for maintaining high prices
- Overview of different types of patient assistant programs across the US
- Examination of the key drivers in PAP development and implementation
- Key findings into the role of PAPs as essential mechanisms in maintaining competitiveness
- Recommendations by payers to increase flexible and ongoing interaction with pharmaceutical companies
- Pharmacy director, government health plan
- Pharmacy director, national health insurer
- Executive Vice President of a national Pharmacy Benefits Manager (PBM)
- Chief Medical Officer, Managed Care Organisation
- Health plan medical director
- Medical director at global level for a major pharmaceutical company
- Health Outcomes director at a US affiliate for a top pharmaceutical company
- “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 $2,500 out of their bank accounts for them to get the drug. My argument with the manufacturer would be don't charge $100,000 for the drug and stop giving away $2,500 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.
1. EXECUTIVE SUMMARY
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
4.1.1. 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
4.2.1.1. Sampling is also seen in a negative light
4.2.1.2. Some payers are concerned that patients are being misled by PAPs
4.2.1. 3Some 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
5.1.4.1. 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. PAYER-PHARMA ENGAGEMENT
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. FUTURE OUTLOOK
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
8. CONTRIBUTORS
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
4.1.1. 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
4.2.1.1. Sampling is also seen in a negative light
4.2.1.2. Some payers are concerned that patients are being misled by PAPs
4.2.1. 3Some 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
5.1.4.1. 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. PAYER-PHARMA ENGAGEMENT
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. FUTURE OUTLOOK
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
8. CONTRIBUTORS
