Author- Dr. Ms.Tanvi Azmi

The healthcare sector has improved greatly in providing new drugs and medical facilities. New advances have given new drugs to many chronic diseases. But the cost is still a hindrance in grabbing these opportunities. The charges of medications/therapy are one among many factors responsible for non-adherence/poor compliance of the patient with prescribed medications. Even after getting help from government services or NGOs, many patients find themselves financially compromised toward the medication approach.¹ As seen in the case of cancer therapy where many patients have lost their life due to the unaffordability of costly anticancer drugs at some point during their prolonged chemotherapy.

Developing countries like India are also not left out of this problem. With a population of 1.412 billion², 53% of total death are considered to be due to chronic diseases³. Only around 25% of the Indian population carries health insurance, the rest of the population pays the bills from their own pockets.⁴ If we look at the data the number of cancer cases has been increasing dramatically and many patients were not able to continue the therapy because it required long-term care, management, and financial stability. The cost of cancer treatment varies for different types of cancer. The average cost of Cancer treatment in India is around 500,000 lakhs.⁵In India the estimated mortality due to cancer in India was 7,70,230 in 2021 which has increased to 8,08558 in 2022.⁶ Those who survived cancer were either landed in financial debt or living in poverty .⁷

Chronic illness not only has an impact emotionally but also financially. Sometimes patient was unable to express themselves or was too shy to talk about the treatment plan or the financial help.  So we need plans, programs, or guidance that can improve patient adherence toward treatment at least from the cost point of view.

Patient assistance programs (PAPs), prescription assistance programs, or drug assistance programs (DAPs) were started in the mid of 2000⁸. They can greatly help needy patients in terms of medication cost coverage. They are part of financial medication assistance which also includes coupon cards, vouchers, and discount cards. DAPs are mainly offered by pharmaceutical companies. They guide eligible patients, meaning those without health insurance or insufficient health insurance coverage. Patients can easily access brand drugs at very low or no cost.¹ This will not only help in improving the quality of life but also improve patient adherence to prescription. DAPs are strictly applied to prescribed drugs and are available in the form of copayment/cost sharing also.⁹ Prescribed medications range from drugs used to treat minor infections to those given for life-threatening conditions like Hypertension, diabetes, and cancer.¹⁰ PAPs are also sponsored by state programs and /or non–profit organizations.¹¹ In 2016 study conducted by Ganguli et al stated that PAP improves care in chronic disease especially involving complex therapies, PAPs carries the potential to improve prescription drug access to appropriate patients ¹² and has shown positive effects on adherence, and clinical and humanistic outcomes. The ultimate goal of these programs is to ease the complicated therapy by providing assessment in terms of financial help.¹³ It has also been found to effectively strengthen the doctor-patient relationship.¹⁴It is the physician’s responsibility to help patients find the right program in case of financial constraints related to medication availability.

However, the eligibility criteria for DAPs may vary from pharmaceutical company to company, mostly considering the income of the family as a major criterion.¹⁵ Also, not all drugs are included in DAPs, only selected drugs were to consider. Few companies ask for them require Medicare to be eligible.¹⁶Apparently data available on DAPs/PAPs is very limited and their procedure is also difficult to understand.⁵Many at times patient not even know that these kinds of programs exists. Few companies provide them in the form of an app for easy accessibility. Few examples are given

Below is the list of Pharmaceutical companies providing DAPs¹⁷

Pharmacy drug saving programs include¹⁷

• Blink health
• GoodRX
• KrogerRX savings club
• Publix
• Walmart prescriptions program

Non-profit copay and premium assistance include¹⁷

Organization

• Good days
• Healthwell foundation
• Needymeds
• Pharma’s medicine assistance tool (MAT)
• Patient access network foundation
• Patient services incorporated

State drug assistance programs¹⁷

• State health insurance assistance programs
• Medicare pharmaceutical assistance programs
• National council on aging

List of PAPs¹⁸

PAPs cannot be done by the patient himself it also involves their health care provider as part of the form filling required physician also.

The responsibilities of patients towards drugs play an important role in improving their health conditions. How to take the prescribed medication, when to take it, how to store them, and how to dispose of expired drugs. These all are patients’ responsibilities to acquire knowledge and improve their health standards. They are responsible for providing correct and complete information about their medical illness. Basic knowledge about the diseases, drugs, their side effects, the cost of therapy and any alternative procedure is there must be provided to the patient.While on medication patients should inform about any side effects, allergies, and changes they face when coming for follow-up. Communication is an important tool for positive results. This will help in decreasing medication errors. At any time if the patient does not understand the proposed management he can very well inform the concerned doctor.¹⁹

Lacunae–

Data and studies are not very much clear about DAPs. These programs are helpful but complicated. Even physician also have less knowledge related to DAPs/PAPs. How to approach them is still not very familiar to the patients. Only some companies are seen promoting them.

Conclusion

PAPs/DAPs are great initiatives for the availability of medications. More awareness and transparency are required for the benefit of the patients. In India, its knowledge, awareness, and data are still lagging behind where the requirement is more than in any other country. More promotions are required and more emphasis should be given to these programs. These programs should be easily approachable by the patients and their carers. Information on these programs is not only needed by the patients but by the treating physician also for better outcomes for chronic diseases. How far these programs will be successful in the future in terms of better patient adherence to medication or decrease death due to disease related to cost will only be known after their effective implementation. Knowledge about the drug is equally important as knowledge about the disease. Patients as well as his/her carer must know details about the medication to avoid medication-related health issues .Cost of medication cannot be neglected just to provide better health. They play an important role and it the duty of health care sector, government and those involve in providing better health to come up with various strategies to reduce the budget without compromising the health of patient.

References –

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15. https://www.jjpaf.org/eligibility/requirements.html. last access on 10/01/2023
16. https://www.gskforyou.com/programs/prescription-medicine-patient-assistance/last access on 10/01/2023

17.https://aafa.org/advocacy/advocacy-resources/patient-assistance-medicine-drug-programs./last access on 31/12/2022

18 .https://www.goodrx.com/healthcare-access/patient-advocacy/what-are-patient-assistance-programs.last access on 10/01/2023

19. https://www.nashunchealthcare.org/patients-visitors/patient-rights-and-responsibilities/. last Access on 31/12/2022