With both novel drug development and drug prices on the rise, concerns about affordability and patient access to medications have never been more relevant. Many patients with chronic conditions depend on resources apart from insurance to bridge financial gaps and obtain potentially life-saving therapies. Often, this help comes in the form of prescription-assistance programs (PAPs) – a term encompassing a wide range of programs helping patients obtain medications at a lower cost to them. Although PAPs do help many patients, they also promote needlessly expensive therapeutic options, increase societal costs, and disrupt important flows of clinical data.
PAPs have arisen rapidly and are still underexamined. The goal of this capstone project was to elucidate how PAPs function, pros and cons for different stakeholders, and how PAPs contribute to data missingness problems. Through key informant interviews and a review of the literature, we captured various perspectives for a comprehensive look into PAPs. Our information came from different pharmacy settings (outpatient, inpatient, and specialty), and from other stakeholders like insurance companies, drug manufacturers, and PAPs themselves. We found that stakeholders unanimously agree that PAPs are successful in improving patient access, adherence, and outcomes when used appropriately, but inappropriate use of PAPs leads to poorly functioning systems and increases in overall healthcare costs. Identifying policies that strike the right balance and are broadly acceptable is a challenge.
Ultimately, our goal is to further the discourse on the role of PAPs and encourage pathways that maximize benefits for individual patients without population-level harms.