Job losses and resignations spurred by the pandemic- coupled with escalating drug costs- have made it increasingly difficult for some patients to afford their specialty therapies. Whether they no longer have health insurance, they can’t afford their policy’s high deductibles and copays, or their insurance doesn’t cover a prescribed medication, affordability can prove a considerable challenge.

Patient assistance programs (PAPs) are designed to remove that affordability obstacle, and help ensure patients can start and stay on life-altering specialty treatment plans. Today, technology solutions are making it easier for manufacturers to offer PAPs that are simpler and faster for patients to apply for and use.

How It Works- Getting the Eligibility Rules Right 

When patients apply for financial assistance, often with the guidance of a case manager or physician, it’s essential to confirm whether they meet the manufacturer’s unique eligibility requirements. For instance, most require that the patient is a US resident and that the patient’s household income doesn’t exceed a certain percentage of the federal poverty level- but those percentages tend to vary by manufacturer. A variety of other eligibility criteria may come into play, and many are unique to each manufacturer or therapy, making one-size-fits-all services ineffective. 

Since patients must be deemed eligible for a PAP before they’re referred to the manufacturer's specialty pharmacy, getting the eligibility step right—and doing so quickly and efficiently—is essential. Once approved, the patient’s eligibility is typically effective through the end of the current calendar year (this is the case for Medicare patients), or for 12 months from the approval date.

With more and more drugmakers using technology to manage the PAP application process for speed and efficiency, systems that can execute on the eligibility rules seamlessly, and with an exceptional degree of accuracy, are vital to the process. For many manufacturers, hub services technology makes that possible. In a recent CareMetx-sponsored survey of manufacturing leaders, results and interviews repeatedly demonstrated the high value of these core hub services in addressing electronic benefit verification, prior-authorization, and patient assistance programs. 

How CareMetx Streamlines PAP Processes 

When the PAP approval process is integrated into the CareMetx Digital Hub and the overall patient journey, the process is even further streamlined. 

Patients referred for PAP support may receive an ePAP invite, with a link that walks them through the electronic process seamlessly and efficiently. Once patients log in, they’re automatically taken to an electronic application form in which they input the required information and apply their digital signatures. 

From there, the CareMetx hub services solution evaluates the application against the manufacturer’s eligibility requirements, which includes automated income verification through an electronic connection to a third-party, health income validation service. If the income data CareMetx receives back doesn't match the income reported in the patient’s PAP application (which occurs in about 25 percent of cases), our team contacts the patient personally to request documentation verifying their income, in whatever form our manufacturer client requires. This additional step ensures that 100 percent of the ePAP applications CareMetx processes can be verified for eligibility—a benefit that’s highly valued by drug manufacturers and patients alike.  

ePAP solutions like these integrate both the eligibility assessment and electronic enrollment steps required for participating in a patient assistance program—helping to remove affordability obstacles and minimizing the risk of a gap in treatment. When patients apply for assistance during the annual re-enrollment season- a time when gaps and delays are more common- a streamlined ePAP application and eligibility review process is especially critical to speeding the patient’s access to a potentially life-saving therapy. 

Meeting a Pressing Need 

PAPs are critical to the health outcomes of countless people, setting patients up for successful treatment experiences at the outset of diagnosis and initial fulfillment. As they continue to play a central role in ensuring individuals can start and stay on complex treatment plans, digital capabilities and advanced technology platforms will play an even greater part in making the PAP approval and enrollment process fast, accurate, and efficient. For more details on how our radically efficient hub services platform and e-services are continually advancing to help achieve goals like these, contact CareMetx.