What are Patient Assistance Programs?

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Patient Assistance Programs

What are Patient Assistance Programs?

Patient Assistance Programs are sponsored by drug manufacturers and provide brand-name drugs directly to qualifying patients at no cost. These programs are designed to ensure that patients are still able to get the medication they need despite financial barriers.

Who qualifies for Patient Assistance Programs?

The exact criteria varies by manufacturer and medication, but most programs have:

  • Maximum income threshold
  • Uninsured or lack of coverage on current insurance plan

How do Patient Assistance Programs work?

  1. The patient or pharmacy fills out the specific program’s eligibility forms and sends them to the manufacturer.
  2. Once these forms are sent, the patient’s provider sends in a prescription to the program.
  3. If the patient is approved, then the manufacturer ships the medication directly to the patient or their provider.

These programs are convenient for patients because they can generally get a 3 month supply of medication at a time and approvals last for a full year.

How can my Pharmacy Benefit Manager help with Patient Assistance Programs?

Since Patient Assistance Programs provide brand-name drugs, these are often expensive or specialty medications. Pharmacy Benefits Managers can help insurance plan members navigate the enrollment process and answer any questions that arise. Sona Benefits has helped several of our clients’ members enroll in Patient Assistance Programs and receive needed medications like Dupixent and Humira, which would have otherwise cost over $35,000 and $146,000 over the course of a year.

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