Pharmaceutical Patient Assistance Programs (PAPs) encompass a sometimes-bewildering array of free- or reduced-cost drug programs, drug co-pay programs, subsidies, and grants; these programs are for uninsured or underinsured low-income patients or the pharmacies, clinics, or hospitals that serve them. Some PAPs are administered directly by pharmaceutical companies, though many are offered through independent nonprofit organizations.

“There is a huge need for these programs,” said Lisa Vlastelica, PharmD, BCOP, GI Oncology Clinical Pharmacist at Duke University Medical Center in Durham, North Carolina. “Even with insurance, patients have difficulty affording treatment.”

More patients have insurance under the Affordable Care Act (ACA), Dr Vlastelica noted. “But they can still be associated with high premiums and deductibles,” she said. “I think the majority of patients still get treatment, but they face high out-of-pocket costs, or therapy may be switched to something that is equivalent but less convenient and less expensive.”

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Most drug companies offer PAPs, but surprisingly few health care providers are familiar with these programs. Among providers who were aware of PAPs, a third had learned about them from their patients, according to a survey of 87 respondents conducted in October 2015.1

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“As oncologists, we are infrequently informed about when our patients are experiencing financial pain,” said S. Yousuf Zafar, MD, MHS, associate professor of medicine and public policy at the Duke University School of Medicine and a member of the Duke Cancer Institute. “We don’t often know when our patients are having trouble paying for treatment, because we don’t ask, and they don’t often tell us.”

It doesn’t help that drug companies are sometimes surprisingly quiet about these programs, he noted. Pharmaceutical Research and Manufacturers of America (PhRMA) and drug companies contacted with interview requests for this story did not respond.