Friday, August 07, 2020

Patient Assistance Programs–Weathering COVID-19 and the Unknown

Today’s guest post comes from Rob Brown, VP/GM of RxCrossroads by McKesson Program Pharmacy.

Rob reviews how COVID-19 is changing patient access and adherence to specialty therapies. He then describes specific RxCrossroads’ program changes that are helping patients and providers remain on therapy and navigate this challenging environment.

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Read on for Rob’s insights.

Patient Assistance Programs–Weathering COVID-19 and the Unknown
By Rob Brown, VP/GM of RxCrossroads by McKesson Program Pharmacy

Patient Assistance Programs (PAP) are a critical safety net for millions of patients with financial hardship. Even prior to the COVID-19 pandemic, nearly 28.5 million Americans were uninsured or underinsured, leaving them at risk for medical costs they may not be able to afford.

As COVID-19 hit the U.S. in March, stakeholders across healthcare, including payers, providers, and biopharma companies, became concerned about a surge in the number of uninsured patients. With millions of Americans losing their jobs as a result of COVID-19, millions more people could require free medications to access and maintain adherence to specialty therapies.

With more than 17 years of experience, RxCrossroads by McKesson implements comprehensive PAPs to provide drugs to eligible patients being treated at hospitals (CAH, ACH, academic centers), in their community care settings and at home. RxCrossroads administers more than 50 active PAPs and processed approximately 300,000 PAP applications last year and dispensed more than 1.6 million prescriptions for patients in these programs. As the industry braced for the potential surge of patients, we immediately started working with customers to integrate flexibility, adjust program business rules and ease eligibility guidelines to help patients receive rapid and uninterrupted access to therapies.


We worked with many PAP providers to quickly loosen income eligibility guidelines and facilitate transfers of patients to PAP from commercial insurance and extend enrollment timeframes. In many cases, we also provided an increased supply of medications (3 month supply instead of a one month supply) to help reduce exposure to the coronavirus and minimize the unknown implications to our supply chain. Here are some specific examples of program changes that we have implemented with customers during COVID-19:
  • Created a special enrollment period for COVID affected patients, granting immediate 4-month eligibility and waiving the Federal Poverty Level (FPL) requirements;
  • Implemented a patient outreach program where our agents called every patient before denying them to ask if they had any change in income due to COVID and evaluated that against the FPL;
  • Provided assistance with expiring enrollments by offering a 3-month extension to patients whose enrollment term will expire, during the pandemic, if they are not able to visit their physician and/or complete a new enrollment due to COVID-19 limitations;
  • Assessed patients’ real-time financial situations allowing newly uninsured patients to use their current situation to vet financial eligibility (versus using annual gross household income);
  • Offered new options to collect signatures on enrollment forms via electronic signatures, scans or photographed image of the patient’s and/or healthcare provider’s signature or form.

I’m proud to say that, as an industry, we reacted quickly with extreme flexibility and implemented thoughtful program changes to help patients start and maintain their prescription treatment regimens. As a result of this decisive action, we’ve made it through the first wave of demand from COVID-19. However, the fact is that we haven’t seen the massive surge in PAP applications that we initially anticipated – yet.

There are a number of possible reasons for a slower influx of patients in need. For example, just because somebody gets furloughed or loses their job, it doesn’t mean that their annual income changes right away. Some people may have coverage through their partner or spouse and others may have had their benefits extended temporarily. At the same time, there is also significant potential for unemployment to continue to climb as we experience COVID-19 hot spots and as we move into the Fall and Winter and traditional flu season.

As we prepare for potential new surges, there are some simple steps that biopharma companies and PAP service providers can take to maximize access and patient support. Learned from working with customers over the past several months this starts with allowing electronic signatures and facilitating online enrollment to make PAP enrollment easier and faster.

Most of the business rules associated with getting a patient enrolled into a PAP program have to do with their income as a percent of the FPL. Temporarily easing financial eligibility criteria and reducing manual validation of income levels can streamline the process and get patients onto therapy quicker. For example, some biopharma companies have allowed patients to self-notify of their loss of employment to qualify without manual validation and document collection.

Finally, it’s not just potential surges that we have to prepare for. There are legislative issues, election impact, as well as re-enrollment season that can impact PAPs moving forward. From payers and PBMs, to Federal and state policy, restrictions on PAP medication access are complex and ever-changing. Biopharma companies must stay informed about the policies and dynamics shaping legislative decisions and considerations for using data and best practices to align PAP programs with potential new policy changes.

In this difficult consumer environment, we must continue to work together to emphasize continuity of care and to optimize the patient experience — driving access to life-changing therapies and interventions at the right time, in the right place, to the right patient, delivering better care and outcomes.

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