New Paper: Alternative Rx Funding Programs Undermine Patient Health, Complicate Health System

A new policy paper from the Alliance for Patient Access explores the unintended consequences of alternative funding programs

WASHINGTON, June 12, 2023 /PRNewswire/ -- Programs designed to shield employers from the expense of beneficiaries' high-cost medications could undermine patient care and drain funds meant for needy patients, a newly released paper from the Alliance for Patient Access explains. Alternative funding programs use third-party vendors to carve out certain specialty drugs from an employer-sponsored health plan, leaving affected employees reliant on patient assistance programs to get their prescribed medication.

Health plans first categorize certain specialty medications as "non-essential health benefits," then usher affected patients into charitable patient assistance programs.

The programs can produce a host of unintended consequences:

Increasing out-of-pocket costs for patients, who may be on the hook for thousands of dollars after their patient assistance maxes out. 

Reducing quality of care as patients face gaps in coverage and vendors source drugs from overseas sources that may lack safety and efficacy guarantees.

Diverting resources away from the truly needy, as alternative funding programs generate savings for employer-sponsored health plans by misusing charitable programs.

Introducing new challenges for employers, who may experience increased absenteeism or staff turnover as employees face treatment disruption and health complications.

Complicating the drug pricing system, as alternative funding programs worsen the problems created by an already complex and opaque system.

If allowed to grow unchecked, the paper concludes, these programs will continue to hurt patients, impact the broader health care system and worsen the already dysfunctional drug pricing market.

READ: The High Costs of Alternative Funding Programs

STATEMENT FROM JOSIE COOPER, EXECUTIVE DIRECTOR, ALLIANCE FOR PATIENT ACCESS:

"As alternative funding programs become more common, clinicians and patient advocates are eager for more transparency and for policymakers to rein these programs in before they harm more patients and distort a health care system that is already fractured."

The Alliance for Patient Access is a national network of policy-minded health care providers advocating for patient-centered care.

SOURCE Alliance for Patient Access