A new study on Alternative Funding Programs (AFPs), conducted by Leavitt Partners, found that AFPs threaten manufacturer Patient Assistance Programs (PAPs), programs intended to assist the uninsured or underinsured in accessing their medications. Further, the prevalence and use of AFPs are likely to increase, causing further patient harm. The study’s findings reinforced what is already known - that AFPs contribute to delays and interruptions in care and cause patients to shoulder additional administrative burdens.
AFPs are a new scheme targeting commercially insured patients that exploit PAPs by shifting the cost of covering prescription drugs onto them and away from patients’ health coverage.
This new study comes as policymakers, federal and state agencies, the media and others continue to probe into patient-harming practices of opaque middlemen within the health care system.
Here are three things to know from the study:
Higher costs, more hurdles for patients
AFPs typically work with self-funded employers to “carve out” some medications from health insurance coverage for patients and then directly force them to enroll in third-party charitable foundations (typically manufacturer PAPs). The AFP enrollment process increases delays for patients and does not always guarantee that patients will be able to access their necessary medicines. These delays and loopholes could increase both total health care expenditure and harm the patient’s health.
Adoption of AFPs will increase
Employers are led to believe that AFPs will offset drug spending for patients enrolled in their health plan, despite limited evidence to support this belief. The study found that 75% of employers who currently use an APF plan to continue using one, with nearly one in three large employers “exploring their use” for the future.
Depleted patient assistance for those who need it
The study concluded that the increase in AFPs will continue to siphon assistance meant to support uninsured and underinsured patients. These important programs and the assistance they provide should go to the people who need it the most, not to boost the bottom lines of these shady vendors.
Expanded use of AFPs could make it substantially more difficult for the most vulnerable patients to access their medications. Policymakers should take action to make sure that assistance goes to the patients who need it, not to line the pockets of middlemen.
Kate Sikora
Kate Sikora is a Deputy Vice President, Policy and Research at the Pharmaceutical Research and Manufacturers of America. At PhRMA, Kate focuses on a range of commercial health care policy issues across federal and state markets. Kate was previously a Principal at Avalere Health where she supported pharmaceutical manufacturers, health plans, PBMs, and patient advocacy groups in in monitoring, engaging, and developing strategic recommendations across the federal and state health policy landscape. Prior to Avalere, Kate held multiple roles at the American Society of Clinical Oncology (ASCO) where she focused on provider and patient access issues. Kate holds an MBA from the Johns Hopkins University, Carey Business School and a BA in Government & Politics from the University of Maryland, College Park.
Kate Sikora
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Patient Assistance Programs
Tactic to exploit patient assistance likely to increase despite harm to patients
Tactic to exploit patient assistance likely to increase despite harm to patients