Helping Patients to Apply

Online portals and hubs, such as RxHope, provide online lists of PAPs, their eligibility criteria, and contact information.

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The lack of standardized patient-eligibility criteria and application processes, however, is “problematic,” acknowledged Bona E. Benjamin, BSPharm, of the Center on Medication Safety and Quality at the American Society of Health-System Pharmacists (ASHP) in Bethesda, Maryland.

“We hear from our members that while PAPs can significantly ease both the patient’s and the organization’s financial burden for expensive drugs, managing them is resource-intensive, due to highly variable procedures among drug companies, and numerous lengthy forms that must be submitted,” Benjamin told Cancer Therapy Advisor in an e-mail. “Some of the patient populations who need these drugs the most…require significant assistance navigating these barriers.”

Such patients can include indigent or homeless people and those with low health literacy, she noted.

Patients facing a potentially catastrophic diagnosis like cancer can find the process daunting, said Dr Zafar. “The patient has to contact them company, call them, and then they have to fill out and send a packet with paystubs. It can be a challenge.”

Dr Zafar and colleagues’ study of PAP benefits and eligibility requirements found that patients are frequently asked for tax returns, W-2 IRS forms, paystubs, bank statements, and Social Security statements.

Patient navigator programs and other institutional support can help, as can electronic health records (EHR) software and smart phone apps.

“The number 1 nonclinical barrier to prescribing adherence is patients’ out-of-pocket costs,” said Ian Manners, CEO of Vivor in Chicago, Illinois. “The shame is, at the same time, there are all of these assistance programs. …For providers, there is both an obligation and an opportunity to get patients on assistance programs. Dr Zafar has shown how much financial toxicity affects outcomes. It’s also in a practice’s financial interest; they have to buy drugs and then get reimbursed, so when patients don’t pay, providers are on the hook for the cost.”

Manners co-founded Vivor in 2014 and developed a subscription service called PayRX, which helps practices to identify patients eligible for PAPs. The system is already in use at 25 hospitals across the USA, Manners said.

RELATED: Physician Payment Reform: The Path to Affordable Care?

With help from Dr Zafar, Manners’s company is also developing a smart phone app for patients, the first version of which should be released late this year.

“We noticed that a lot of hospitals do not have financial navigation staff to help all of their patients, no matter how much you automate it,” Manners told Cancer Therapy Advisor. “We realized we need to develop a patient-facing tool.”

Once a provider sets up an account for a patient, that patient will complete a survey on a mobile app to find out which programs he or she is eligible for, he said. Providers will pay a fixed fee for each patient.


  1. APCO Worldwide. Survey: How well known are patient assistance programs? Updated June 14, 2016. Accessed July 5, 2016.
  2. Zafar Y, Wolf SP, Watson J, et al. The role of patient financial assistance programs (PAPs) in reducing costs for cancer patients. J Clin Oncol. 2016;34(suppl):e18269.
  3. Zafar Y, Bastian A, Asabere A. Oncology patient assistance programs (PAPs): a first-in-kind analysis of US drug manufacturer program benefits and eligibility requirements. Eur J Cancer. 2015;51(suppl):S176.
  4. Centers for Medicare & Medicaid Services. Prescription drug assistance programs. Updated March 6, 2014. Accessed July 5, 2016.