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Patient Financial Access to Medications in Critical Condition - UMAB Pharmacy Students Hear Solutions from Patient Access Network Foundation President


Rockville, MD, May 5, 2012 – Biopharmaceutical Manufacturers are demonstrating sound corporate social responsibility practices through involvement with innovative programs and charitable foundations that provide financially strapped patients with important medications. But one recent speaker let it be known that their game will need to be stepped up even more if current trends prevail.

That was the message brought home to University of Maryland future pharmacists during a recent presentation to UMAB students by Patrick McKercher, RPh, PhD; president of the Patient Access Network (PAN) Foundation. The PAN Foundation is recognized as one of the leading foundations in patient out-of-pocket funding and is working diligently to bring its message to the public and the medical profession.

During his presentation, McKercher described the broad issues of assistance for patients as well as the increasing number of avenues for pharmacists to help underinsured patients gain access to innovative medications that frequently represent a hardship for insured patients with heavy cost sharing liabilities.

Increased cost-sharing, decreasing employee health benefits, a widening Medicare gap, rising health insurance premiums and a shifting payer mix are all contributing to the growth in the number of underinsured Americans. Underinsured people are generally defined as those who have health insurance (including Medicare) but cannot afford their out-of-pocket medical expenses – sometimes skyrocketing because of a single disease of diagnosis. Many of these consumers have higher deductible and cost-sharing options in order to lower their premium costs. The Commonwealth Fund defines the underinsured as persons who have health insurance but spend 10 percent or more of household income on out-of-pocket medical expenses. For those who are below 200 percent of the Federal Poverty Level, that spending threshold is only 5 percent.

McKercher emphasized that as the financial burden on patients increases, options for accessing life-saving medications become critical, with patient assistance programs playing an increasing role.

The Big Picture

The financial burden on patients to pay for health care has been increasing exponentially in the last few years. For example, the employee portion of costs for commercial insurance increased 20 percent between 2009 and 2011. In 2010, prescription drug expenses accounted for nearly 12 percent of Medicare/Medicaid beneficiaries’ total health care expenses.

Other studies have verified what the numbers reveal – patients are facing difficult financial choices when it comes to paying for medications and often opt to go without medical treatment due to cost.

McKercher told the students that the share of adults under age 65 who went without care because costs increased sharply from 2001 to 2007 (the most recent statistics available), rose from 29 to 45 percent. In 2007, 41% of adults said they had problems paying their medical bills – opting for necessities rather than medical care, using up savings, and taking on credit debt. Anecdotal evidence and medical and media stories are testament to the fact that the situation is worsening for large numbers of people.

Many are surprised to learn how much help is available. All health care providers have long made provisions for accommodating hardship patients. But now others are focusing on those efforts as well.

According to The Zitter Group, there are currently 475 prescription assistance programs available across America. Also, while pharmaceutical manufacturers may offer their own branded and advertised assistance programs for certain medications, eligibility is usually very restricted, excluding Medicare and Medicaid patients due to federal regulations. Many pharmaceutical manufacturers are now also expressing philanthropy as foundation donors – along with private sector organizations and individuals – to organizations such as the Patient Access Network Foundation.

The PAN Difference

Patient assistance foundations such as PAN offer dignified and private application and processing procedures that are sheltered, confidential and protected by law. They accommodate all insurance plans, including Medicare Parts A and B. Diagnosis is completed before patients apply for help and grants are awarded. Awards are not made based on specific products, physician, insurance plan or pharmacy.

That said, PAN does have formal relationships with more than 30 specialty pharmacies – covering 90 percent of the population. PAN works diligently to streamline application and payment processes by providing online specialty pharmacy and provider portals that speed approvals, payments and dispensing for both providers and patients.

McKercher and PAN are not only party to the solutions of today but hope to instill social awareness in future pharmacists. His presentation and goals fit hand-in-glove with Patient Access Network’s efforts to offer help and hope for a healthy tomorrow to patients in need.