For many people, health insurance covers a large portion of their prescription drug costs. But that’s often not enough, and tons of people pay through the nose, taxing their savings and in some cases forcing them to dangerously ration medication.
There is an option to lessen the burden of the high prices of drugs that many people don’t know about. It’s possible to get deep discounts by simply asking drug companies for them.
Drug companies have programs called Patient Assistance Programs (PAPs) that provide brand-name drugs at discounts or for free, through reimbursements and other means. They’re not particularly well-known. According to Health Affairs, which surveyed these programs, most drug companies only provide financial help with a few drugs, about half have foggy eligibility criteria, and most rarely disclose details on how many patients they directly help.
According to the American Cancer Society, there are three main ways people can get “manufacturer support”: coupons, discount cards, and electronic processes that automatically activate a discount in a pharmacy’s system for a patient.
How does this work?
It is not an ideal solution for patients to jump through hoops to figure out how to pay for drugs that keep them alive, but Yahoo Finance reached out to key U.S. drugmakers and a few that responded gave details.
Pfizer, for example, has multiple options through a program called RxPathways that provides financial help. Some of these programs from Pfizer require proof that the patient makes less than 400% of the federal poverty line, adjusted for family size, but others are open to anyone who needs help paying. For some drugs, people can get coupons and prepaid cards to help with copays. One option helps patients save between 35% and 75%, according to Pfizer’s website. The company told Yahoo Finance that it “helped more than 250,000 patients receive over 1.7 million prescriptions for free or at savings.”
Lilly says it had a similar program, and a spokesperson pointed to its Diabetes Solution Center, which opened in August. It helps people find insulin access, helping 10,000 patients per month at lower costs, according to the company.
Merck says it offers copay assistance for many products, but doesn’t report how many people use them.
An imperfect system
The system is not perfect. Federal regulations don’t allow people on Medicare Part D and other federal programs to get additional discounts. And a recent in-depth story from California Health Line and Kaiser Health News noted that these forms of assistance mask the true costs of a drug, make insurance companies pay more, are unnecessarily filled with red-tape, and contribute to higher drug prices. That’s why some states like California and New Hampshire have considered legislation to limit these programs, according to the American Cancer Society.
Groups like the the American Cancer Society acknowledge these concerns but sidestep them, because these programs are very useful to many patients. Independent of considering other effects, “Patient assistance programs help enrollees to have access to the most appropriate prescription drugs,” the group wrote of the discounts. “Prohibiting the use of these programs could deny cancer patients access to medically necessary prescription drugs.”
Overall good or bad aside, any assistance at all may mean everything to a patient struggling to purchase a necessary medication. It may be a pain to deal with, but it’s free to ask.