The retail cost of prescription medications increased an average of 7.4% annually from 1993 to 2003. This has significant implications for the millions of Americans who lack health insurance or prescription drug coverage. Among individuals with health insurance plans, 1 in 10 individuals age 65 years or younger and 1 in 3 persons over age 65 years lack prescription drug coverage. While not all individuals who lack prescription drug coverage face financial hardship, it is well documented that medication costs often impede access and adherence to medication regimens. Individuals without prescription drug coverage are more likely to skip doses or not fill prescriptions in order to lower medication costs. While physicians are aware of the high cost of prescription medications, they often are unaware of patients' out-of-pocket costs. Evidence indicates that conversations between the provider and patient regarding the burden of out-of-pocket expenses are infrequent.
Patient assistance programs (PAPs) are offered by pharmaceutical companies to help provide brand-name medications for low-income individuals who lack prescription drug coverage. While these programs have the potential to increase patients' access to needed medications, many patients who qualify for these programs may not be aware that they exist. Many PAPs can only be found on the Internet, limiting the programs' use to individuals with computer access. Therefore, difficulty in obtaining information and applications may hinder PAP use.
Manufacturer-sponsored PAPs have been used in various health care settings, such as hospitals and ambulatory care and specialty clinics, to improve patient access to needed medications at little or no cost. While the main objective of PAPs has been to increase patients' access to medication, limited evidence indicates that PAPs may also improve health outcomes in patients who qualify for PAPs, including increased adherence to medication regimens resulting in improved control of surrogate measures, such as blood pressure and hemoglobin A1c.
MEDBANK of Maryland, Inc. is a statewide 501(c)(3) nonprofit organization that helps the uninsured and underinsured who are eligible for PAPs gain access to brand-name prescription medications. MEDBANK funds operations through state and foundation grants, as well as monetary donations from individual sponsors. Since its conception, MEDBANK has helped patients access $64.9 million worth of free medications. MEDBANK acts as a conduit among patients, providers, and pharmaceutical manufacturers to obtain the information necessary to submit new applications, refills, and renewal applications.
RxBridge, a Web-accessible database developed by MEDBANK, allows for required patient and physician data to be entered into a standardized format. The program allows the pharmaceutical company's PAP application to be selected and merged with the appropriate applicant and physician information. The completed application is then printed out for the physician's and applicant's signatures. Over 100 company programs are represented in the database, comprising over 800 brand-name medications.
In addition to helping patients complete PAP applications, MEDBANK has partnered with pharmaceutical companies to establish an inhouse pharmacy to increase the speed at which patients can receive select medications. Since 2001, MEDBANK has processed approximately 250,000 prescription requests for over 30,000 patients. In 2004 alone, MEDBANK had 10,000 active patients receiving prescription medications.
The purpose of this article is to describe pharmaceutical manufacturer-sponsored PAPs and their enrollment process and to demonstrate the complexity of accessing PAPs using a convenience sample of MEDBANK enrollees. While disease-specific foundations and patient advocacy organizations exist that may assist patients with medication access, this article focuses solely on manufacturer-sponsored programs.