How a Patient Assistance Program Helped Employers and Patients Save Thousands on High-Cost Drugs
Prescription drugs in the US cost on average 256% more than in similar countries, according to the RAND Corporation. This discrepancy is even higher when it comes to brand-name drugs, which fuel most of US prescription drug costs.
Many of these high-cost, brand-name drugs are filled to treat rare and often life-threatening diseases, leaving patients—and often, their employers—with little choice but to pay up or skip the medication. 3 in 10 Americans say they have not taken a medically necessary drug because they could not afford it, according to the Kaiser Family Foundation.
These high-cost drugs can also be a huge financial burden to self-insured employers—particularly smaller employers—and might cause employers to meet their stop-loss insurance premium quickly.
At Flume, we believe there is a better way. Our prescription advocacy partners help connect employers and their employees with Patient Assistance Programs and other support to reduce costs.
What Are Patient Assistance Programs?
Patient Assistance Programs (PAPs), sometimes known as Manufacturer’s Assistance Programs (MAPs), provide financial assistance to patients who could not otherwise afford these high-cost drugs. In order to be eligible, patients typically must be uninsured or underinsured, as well as meet some income requirements.
How Can Employers and Employees Reduce Prescription Drug Costs?
By partnering with ScriptSourcing, a prescription advocacy partner, we recently helped two groups dramatically reduce the cost of specialty prescription drugs. ScriptSourcing reviews certain drugs to see if they are eligible for a Patient Assistance Program, or if the drug is available through the International Pharmacy Program, which sources the drugs from countries with the same or higher standards than the FDA.
One employee was prescribed a high-cost, brand-name drug for a rare autoimmune disease. A 90-day supply of the drug cost nearly $24,000. Data from group’s pharmacy benefit manager (PBM) flagged the pre-certification for the high-cost drug in Flume OS, and triggered a connection to ScriptSourcing to inquire about a PAP.
The patient was eligible, and as a result, had a $0 copay for the vital drug. The employer owed just $4,000.
Another employee was prescribed a drug for a rare neurological disorder that would cost $9,300 for a 25-day supply ($135,780 per year to the plan, full $6,500 OOP Max for the member). When the employee enrolls, they will have a $0 copay, and the group will pay just a fraction of the actual drug cost.
Enrollment in the plans does not disrupt the prescription regimen, and puts patients directly in touch with the manufacturer to fill all subsequent orders.
By lowering costs, employees are more likely to adhere to their drug regimen and maintain their health. In turn, the employer lowers costs and gets a happier, healthier workforce.