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DRUG ASSISTANCE PROGRAMS AND PATIENT RESPONSIBILITIES ON DRUGS

Author: Balusupati Anjali Venkata Lakshmi

ABSTRACT: Drug Assistance Programs are the programs offered by pharmaceutical companies, non profits and government agencies in order to provide free or low cost medicines to the patients if they don’t have insurance or are underinsured and can’t afford medicines. The incidence and prevalence of noncommunicable diseases are on the rise and in order to overcome such diseases prolonged treatment and compliance to that treatment are very important, the cost should not be barrier for that for this reason these programs are necessary. As more number of people get health benefits by these kind of programs the patients should also take responsibility towards their medicines. In this article I’m going to discuss what is Drug Assistance Program, why it is needed, examples of such programs like Ayushman Bharat, Aarogyasri what are the merits and demerits of the programs and finally patients responsibilities on drugs.

INTRODUCTION

Drug Assistance Programs: These are the programs offered by pharmaceutical companies, non profits and government agencies in order to provide free or low cost medicines to the patients if they don’t have insurance or are underinsured and can’t afford medicines. [1]

Source: Prescription Medication Assistance Program – HealthyPlace

Purpose of these Programs:

Here I want to share one narration A female of 18 years old got married after 1 year she gave birth a male baby and at the age of 20 her husband died now she was only looking after her baby by doing job as a daily wage worker one day while she was cooking she got cough with blood and the boy was 10 years old the next day she and her son went to doctor for the check up they done all the tests and finally the doctor revealed that she has a cancer and to cure that money is needed that innocent boy also started working with her and started saving money for the treatment of his mother one day he took all his savings to the hospital which was around Rs. 1000 and asked one nurse to treat and save his mother the nurse felt very sad by the innocent boy words and said that these are not enough to cure the cancer the boy also felt very sad and started working more but that innocent boy don’t know that for the treatment it takes some lakhs of rupees on the other hand his mother health was gradually becoming very worse and finally his mother died.

Now what was the reason behind his mother death? Obviously it was cancer but what was the reason behind not getting treated even though she know that she has a cancer? The answer is lack of money and poverty because of these reasons she died if they had money she might be cured or her life might be prolonged. There should be some source or schemes or programs to avoid these kind of bitter stories. For this reason these Drug Assistance Programs are necessary.

In majority of cases the effective treatment is necessary to cure the disease or to overcome the health condition in such situations the patient may have to afford more money and by facing such out of pocket costs some patients may decide against taking an expensive medication and there may be chances of taking medications which are low in cost but may not be effective for the treatment. By implementing this kind of programs the patients who became nonusers of effective treatment get converted to users and finally they get cured more fastly and easily. [2]

Drug Assistance Program is not only related to the cost of drugs but also the assistance to the usage of devices like for example first time insulin takers are apprehensive about how the insulin pen works and some may fear of injectables and make it even worse for such patients who are not guided completely in order to assist to use of the device and imparting confidence to the first time insulin taker is necessary. [3]

Statistics: According to industry sources, more than 300 drugs have associated drug assistance programs, and for this manufacturers spend about $4 billion per year. These are triple boon for manufacturers as they can increase their demand, allow companies to charge higher prices and provide public relations benefits [3].

Fig : Percentage of MNCs who have outsourced PSPs [3]

In India according to the study conducted by BioQuest Solutions Pvt. Ltd. During the summer of 2019 around 75% of the MNCs such as Roche GSK Janssen were outsourcing their Patient Support Programs. [3]

Perspectives [3]

From the Company’s and Program’s Perspective Before launching Patient Support Program firstly the patient’s journey should be studied and identify gaps then introduce these programs to address the gaps. An audit should be conducted rather than intermittent document checks at regular intervals to get a clear picture of the patient retention statistics. Patient profiling is done to tackle different patients.

From the Patient’s Perspective

• Financial assistance like offering free products for one cycle after the patient has purchased two cycles of drugs.
• Emotional counselling
• Education and counseling the family members about patient condition.
• 24*7 call support team to clarify the patients doubts.
• Discounted home delivery of medicines.

Examples of Drugs Assistance Programs

Government Programs (in India)

Ayushman Bharat: It is a National Health Protection Scheme that will cover over 10 crore poor and vulnerable families providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization. To control costs the payments for treatment will be done on package rate (to be defined by the Govt. in advance) basis. [4] The Health cover under AB-PMJAY includes all the expenses incurred for the hospitalization of beneficiaries and it includes the following components

• Medical examination, treatment and consultation
• Pre hospitalization
• Medicine and medical consumables
• Non–intensive and intensive care services
• Medical implant services
• Accommodation benefits

Source: Ayushman Bharat Yojana – Wikipedia

• Food services
• Complications arising during treatment
• Post – hospitalization follow-up care up to 15 days.

They provide services related to

• Non – communicable diseases
• Mental health
• ENT
• Ophthalmology
• Oral health
• Geriatric and palliative health care
• Trauma care in addition to the existing services of RCH and communicable diseases. [5]

It covers 1393 defined packages, including one unspecified surgical package and 24 specialities. [6]

Eligibility for PMJAY rural

• Those living in scheduled caste and scheduled tribe households.
• Families with no male member aged 16 to 59 yrs.
• Beggars and those surviving on alms.
• Family with no individual aged between 16 to 59 years.
• Families having atleast one physically challenged member.
• Landless households
• Primitive tribal communities
• Legally released bonded laborers
• Families living in one room makeshift houses with no proper walls or roof.

Eligibility for PMJAY Urban

• Washerman
• Ragpickers
• Mechanics, electricians, repair workers
• Domestic help
• Sanitation workers, gardeners, sleepers
• Home-based artisans or handicraft workers, tailors.
• Cobblers, hawkers and other services are provided on streets or pavements.
• Plumbers, masons, construction workers, porters, welders, painters and security guards.
• Drivers, conductors, helpers, cart /rickshaw pullers
• Assistants, peons, delivery boys, shopkeepers and waiters. [7]

Aarogyasri

Fig Source [9]

It is the flagship scheme of all health initiatives of the State Government with a mission to provide quality healthcare to the poor. The aim of the Government is to achieve Health for All [8]. It covers most of the diseases that affect the people in Telangana. It gives INR 2 lakhs per year, in case they are suffering from serious ailments. [9]

Eligibility: The beneficiaries of the scheme are the members of Below Poverty Line (BPL) families as enumerated and photographed in BPL Ration Card. [8]

It includes ailments of Heart, lungs, pancreas, kidney, liver, neurosurgery, congenital malformations for children, post-burn contracture surgeries for functional improvement, prostheses, burns, cancer treatment which include chemotherapy, surgery and radiotherapy, cochlear implant surgery and polytrauma. Initially Rs. 1.5 lakh of total amount is released if it crosses the amount an additional sum of Rs. 50 thousand will be released. In case of Implant Surgery with Auditory Verbal Therapy, the upper cap is fixed at a sum of Rs. 6.50 lakhs. [9]

Examples of Pharmaceutical Companies which has Drug Assistance Programs

Patient Assistance Programs (PAPs)  offered by pharmaceutical manufacturers provide eligible patients with access to brand-name medication at little or no cost. [10]

Table Source [1]

In India [3]

Merits

• More number of people get access to quality and effective treatment.
• It becomes easier to access to medicines for chronic diseases.
• The patients can get clarified their doubts about the medications and treatment procedures.

Demerits [2]

• These may discourage patients from using generic drugs and other less costly alternatives to new, patent-protected therapies.
• Some programs provide assistance for high-cost drugs that have no generic equivalence or close therapeutic substitutes in such cases, these programs can expand access to therapies that represent the standard of care.

Patient Responsibilities on Drugs

As the pharmaceutical companies, governments and nonprofits are providing drug assistance programs through which costly medicines or treatments are available at low cost or no price the patients should also be responsible towards the medications in order achieve the good results of drugs. Here are some responsibilities of patients on drugs.

• Give accurate clinical and contact information and notify the changes in this information.
• Adhere to the plan of treatment or service established by your physician or healthcare provider.
• Clarify your doubts
• Care for and safely use medications, supplies and / or equipment, according to instructions provided, for the purpose they were prescribed and only for / on the individual for whom they were prescribed. [11]
• Patients are responsible for what happens if they refuse the planned treatment. [12]
• Improve communication about side effects and early warning symptoms that something is not right. [13]

Conclusion: Drug Assistance Programs are the programs which are offered by pharmaceutical companies, government and non profits agencies to provide free or low cost medicines to the patients if they don’t have insurance or are underinsured and can’t afford medicines. These programs are necessary in order to make availability of safe and effective treatment for patients especially those who are suffering from chronic diseases. As the Drug Assistance Program providers are making efforts for providing better healthcare to patients they also be responsible towards their treatment like following the instructions given by healthcare providers, notify the changes in health from time to time etc. I hope there would be friendly relationship between the pharmaceutical companies, government and patient through these programs and more programs should be developed in order to make the healthier world.

References

• Drug Assistance Program

Asthma and Allergy Foundation of America Drug Assistance Program

https://aafa.org/advocacy/advocay-resources/patient-assistance-medicine-drug-programs/

• David H. Howard, Ph. D, Drug Companies Patient – Assistance Programs – Helping Patients or Profits? The New England Journal of Medicine; N Engl J Med 2014;371:97-99

https://www.nejm.org/doi/full/10.1056/NEJMp1401658

• Shubhra Seal, Arun Kumar S, Gramle Amol, Nafsia Vaz, The Ecosystem of Patient Support Programs (PSPs) in India. International Journal of Management and Humanities (IJMH); ISSN : 2394 – 0913 (online), Volume 5 Issue 10, June 2021

https://www.ijmh.org/wp-content/uploads/papers/v5i10/J13330651021.pdf

• Ayushman Bharat – National Health Protection Mission

https://www.india.gov.in/spotlight/ayushman-bhart-national-health-protection-mission

• Press Information Bureau Government of India Ministry of Health and Family Welfare. Medical Facilities provided under Ayushman Bharat Yojana, 11 – February – 2020 15:09 IST
• All About Ayushman Bharat Yojana, Eligibility and Application Process

https://www.bajajfinserv.in/insights/ayushman-bharat-yojana-are-you-eligible-for-the-pmjay-scheme

• Aarogyasri of Telangana

https://vikaspedia.in/health/nrhm/state-health-programmes/aarogyasri-of-telangana

• Aarogyasri Scheme in Telangana – Hospital List, Surgery list, Diseases List 15 – 09 – 2017 by Sehat

https://www.sehat.com/aarogyasri-scheme-telangana-hospitals-diseases-surgery-list

• Niteesh K Choudhry, Joy L. Lee, Jessica Agnew Blias, Colleen Corcoran and William H. Shrank. Drug Company Sponsored Patient Assistance Programs. Health Aff (Millwood), 2009 May – Jun; 28(3) : 827-834
• Patients Rights and Responsibilities – Everwell

https://www.everwellrx.con/patoent-rights-and-responsibilities

• Patient Rights and Responsibilities

https://www.nashunchealthcare.org/patients-vistors/patient-rights-and-responsibilities

• Michaels Ross MD, MHA. What’s the Patient’s Responsibility in Preventing Medication Errors? Jul 5, 2018

https://blog.cureatr.com/whats-the-patients-responsibility-in-preventing-medication-errors